Clinical Anatomy of the Descending Genicular Artery and Genicular Arterial Network for Embolization and Reconstructive Surgery: A Systematic Review and Evidence Map with Targeted Meta-Analysis

Background/Objectives: The descending genicular artery (DGA) is relevant to genicular artery embolization (GAE), medial femoral condyle and perforator flaps, recipient-vessel selection, and vascular complications around the knee. This review integrated cadaveric, imaging, procedural, reconstructive, and safety evidence and examined whether bilateral cadaveric sampling affected pooled estimates. Methods: PubMed/MEDLINE, Scopus, Web of Science/SCIE, CENTRAL/Ovid, and LILACS/BVS were searched through 10 June 2026, followed by a targeted update on 18 August 2026. Evidence was stratified by design; anatomical prevalence was not pooled with in vivo visualization. Anatomical studies were appraised using an AQUA-adapted framework, imaging studies using the JBI analytical cross-sectional checklist, reconstructive series using the JBI case-series checklist, and case reports using the JBI case-report checklist. Compatible outcomes were synthesized with REML random-effects models and Knapp–Hartung confidence intervals. Results: Sixty-five primary studies were included, and 22 contributed to at least one quantitative synthesis. Strict cadaveric DGA presence was 91.6% (95% CI 86.6–94.8; I2 = 30.3%); a worst-case cluster-adjusted sensitivity estimate accounting for bilateral specimens was 89.7% (84.7–93.2%). Femoral/superficial femoral origin was 92.4% (89.2–94.7), popliteal origin 3.2% (2.2–4.6), and an articular/osteoarticular branch 90.3% (84.1–94.2). In vivo DGA visualization during GAE-related imaging was 95.9% (93.1–97.6) and was interpreted separately from anatomical prevalence. Reconstructive and safety evidence was predominantly derived from small series and case reports. Conclusions: The DGA is usually identifiable and generally arises from the femoral arterial system, but branch-level variability remains clinically important. Cadaveric anatomy and procedural imaging are complementary. The anatomical findings may inform GAE and reconstructive planning, whereas clinical safety and reconstructive conclusions require confirmation in larger cohorts.