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- Title
Systematic review and meta-analysis of the early and late outcomes of open and endovascular repair of abdominal aortic aneurysm.
- Authors
Stather, P. W.; Sidloff, D.; Dattani, N.; Choke, E.; Bown, M. J.; Sayers, R. D.
- Abstract
Background Any possible long-term benefit from endovascular ( EVAR) versus open surgical repair for abdominal aortic aneurysm ( AAA) remains unproven. Long-term data from the Open Versus Endovascular Repair ( OVER) trial add to the debate regarding long-term all-cause and aneurysm-related mortality. The aim of this study was to investigate 30-day and long-term mortality, reintervention, rupture and morbidity after EVAR and open repair for AAA in a systematic review. Methods Standard PRISMA guidelines were followed. Random-effects Mantel-Haenszel meta-analysis was performed to evaluate mortality and morbidity outcomes. Results The existing published randomized trials, together with information from Medicare and SwedVasc databases, were included in a meta-analysis. This included 25 078 patients undergoing EVAR and 27 142 undergoing open repair for AAA. Patients who had EVAR had a significantly lower 30-day or in-hospital mortality rate (1·3 per cent versus 4·7 per cent for open repair; odds ratio ( OR) 0·36, 95 per cent confidence interval 0·21 to 0·61; P < 0·001). By 2-year follow-up there was no difference in all-cause mortality (14·3 versus 15·2 per cent; OR 0·87, 0·72 to 1·06; P = 0·17), which was maintained after at least 4 years of follow-up (34·7 versus 33·8 per cent; OR 1·11, 0·91 to 1·35; P = 0·30). There was no significant difference in aneurysm-related mortality by 2 years or longer follow-up. A significantly higher proportion of patients undergoing EVAR required reintervention ( P = 0·003) and suffered aneurysm rupture ( P < 0·001). Conclusion There is no long-term survival benefit for patients who have EVAR compared with open repair for AAA. There are also significantly higher risks of reintervention and aneurysm rupture after EVAR.
- Subjects
TREATMENT of abdominal aneurysms; ENDOVASCULAR surgery; SYSTEMATIC reviews; META-analysis; HEALTH outcome assessment; MORTALITY
- Publication
British Journal of Surgery, 2013, Vol 100, Issue 7, p863
- ISSN
0007-1323
- Publication type
Article
- DOI
10.1002/bjs.9101