Table 1_Femoral artery pseudoaneurysm in Behçet's syndrome: long-term outcomes and associated factors.xlsx

A systematic literature search was conducted for descriptive IPD meta-analysis.</p>Results<p>The cohort (median age 34 years, 85% male) underwent endovascular (n = 6), open (n = 6), or hybrid (n = 1) repair. Median follow-up was 60 months (all ≥36 months). Five-year EFS was 69.2% in primary analysis and 76.9% in sensitivity analysis.

Endovascular and open approaches showed comparable EFS (p = 0.992). Elevated NLR, PLR, SIRI, and IBI were associated with lower 5-year EFS (50.0% vs. 85.7%), with SIRI showing the strongest trend (p = 0.131); SII (p = 0.787) and ESR (p = 0.994) showed no trend. Three patients (23.1%) developed de novo aneurysms beyond 5 years, all after immunosuppressive discontinuation.

In a supplementary four-level adherence analysis, no patient was fully adherent perioperatively; preoperative-only use (n = 2) showed the highest disease-specific 5-year EFS (100%). The cohort showed mucocutaneous predominance (oral ulcers 92.3%) and venous involvement in 38.5%. IPD meta-analysis (40 individual cases + 12 series) confirmed a temporal mortality decline from 26%–40% (early open) to 0%–5.8% (contemporary endovascular).

Published case reports (median follow-up 6 months) reported 11% recurrence, vs. 31% in our 60-month cohort, confirming systematic underestimation.</p>Conclusion<p>The recurrence burden after BS–FAP surgery is systematically underestimated in short-follow-up literature; surveillance should extend beyond 5 years. Immunosuppressive adherence is a modifiable target for recurrence control. SIRI emerges as the most promising biomarker for risk stratification.

Endovascular and open repair offer comparable long-term EFS. This exploratory study supports a comprehensive pathway of “surgical intervention—uninterrupted immunosuppression—extended surveillance,” with adherence incorporated into quality metrics.</p>