Single vs. Dual Antiplatelet Therapy after Fenestrated and Branched Endovascular Aortic Repair: A Systematic Review and Meta-analysis

Objective This study aimed to compare single vs. dual antiplatelet therapy after fenestrated or branched endovascular aortic repair (FBEVAR). Data Sources PubMed, MEDLINE, Web of Science Core Collection, Scopus, and ProQuest Dissertations & Theses Global were searched from inception to 12 July 2026, with a supplementary targeted PubMed search on 5 September 2026. Review Methods Comparative studies of post-operative antiplatelet therapy were included. Methodological quality was assessed using the Newcastle–Ottawa Scale, and certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. Outcomes were synthesised narratively when clinical and methodological differences precluded meaningful pooling; an additional quantitative summary of study defined bleeding outcomes was also reported. Results Six retrospective cohorts comprising 3 623 patients were included, with 3 197 patients in separately extractable single or dual antiplatelet therapy groups. Several studies reported associations favouring dual antiplatelet therapy for target vessel patency. However, differences in outcome definitions, analytical units, and treatment classification precluded a common pooled estimate, and one association was attenuated after accounting for treatment changes. Evidence regarding ischaemic events, mortality, re-intervention, and endoleak was insufficient for reliable pooled comparisons. Five cohorts reported peri-operative bleeding using heterogeneous definitions and observation periods, of which a four study summary yielded an odds ratio of 1.30 (95% confidence interval 0.87 – 1.94) for dual vs. single antiplatelet therapy. Given the differences in outcome definitions, this does not estimate a common clinical effect. Conclusion The current evidence comparing single and dual antiplatelet therapy after FBEVAR is based on heterogeneous cohort studies, focuses largely on surrogate outcomes such as target vessel patency, and shows no clear benefit for dual antiplatelet therapy. Comparative bleeding risk as well as clinical outcomes of single vs. dual antiplatelet therapy after FBEVAR remain uncertain. Future prospective studies are needed to better delineate superiority of one regimen over the other.