We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Elective Endovascular vs Open Repair for Elective Abdominal Aortic Aneurysm in Patients ≥80 years of Age: A Systematic Review and Meta-Analysis.
- Authors
Wang, Guohua; Sun, Yifeng; Lin, Zhiqiang; Fei, Xiaozhou
- Abstract
Objective: To provide updated, pooled evidence on clinical outcomes among octogenarians (aged ≥80 years) with abdominal aortic aneurysm (AAA) managed by elective endovascular repair, compared to conventional open repair. Methods: PubMed, Embase, and Scopus databases were systematically searched. Studies that were either observational or randomized controlled trials were considered for the review. Included studies were conducted in elderly subjects (≥80 years) with AAA, and clinical and mortality outcomes were compared between endovascular and open surgical repair. Those reporting on outcomes of patients with urgent repair were excluded. The primary outcomes of interest were mortality and risk of complications. The pooled effect sizes were reported as odds ratio (OR) for categorical outcomes and weighted mean difference (WMD) for continuous outcomes. STATA software was used for statistical analysis. Results: The meta-analysis included 15 studies. Compared to those undergoing open repair, patients receiving endovascular repair had significantly reduced risk of immediate post-operative mortality (OR.23, 95% CI:.20,.27), overall complication (OR.30, 95% CI:.20,.44), cardiac (OR.23, 95% CI:.16,.35), renal (OR.29, 95% CI:.18,.46), pulmonary (OR.14, 95% CI:.09,.21) and bleeding related (OR.59, 95% CI:.42,.83) complications. The risk of mortality at latest follow up (at 36 months and 60 months) was similar in the two groups. The total blood loss (ml) (WMD -1126.47, 95% CI: −1497.81, −755.13), operative time (min) (WMD -29.40, 95% CI: −56.19, −2.62), length of intensive care unit stay (days) (WMD -2.27, 95% CI: −3.43, −2.12) and overall hospital stay (days) (WMD −6.64, 95% CI: −7.60, −5.68) was significantly lower in those undergoing endovascular repair. Conclusions: Endovascular repair appears to be better than open repair of AAA in this high-risk, frail population, with respect to short term outcomes. The benefits of reduced risk of short term mortality, complications, and better peri and post-operative outcomes may be considered when making a choice between these two surgical approaches. Randomized controlled trials are needed to provide reliable evidence on the effect of EVAR on long term survival.
- Subjects
ELECTIVE surgery; OCTOGENARIANS; ONLINE information services; LENGTH of stay in hospitals; INTENSIVE care units; SURGICAL blood loss; ABDOMINAL aortic aneurysms; MEDICAL information storage &; retrieval systems; META-analysis; CONFIDENCE intervals; FRAIL elderly; SYSTEMATIC reviews; TREATMENT effectiveness; ENDOVASCULAR surgery; MEDLINE; ODDS ratio; DATA analysis software; OLD age
- Publication
Vascular & Endovascular Surgery, 2023, Vol 57, Issue 4, p386
- ISSN
1538-5744
- Publication type
Article
- DOI
10.1177/15385744221149911