Long-Term Outcomes of Endovascular vs Open Surgical Repair for Abdominal Aortic Aneurysms: A Meta-Analysis of Randomized Trials

Abstract

ObjectiveThe aim of this meta-analysis was to investigate whether Endovascular abdominal aortic aneurysm repair (EVAR) is inferior to open surgical repair in terms of adverse events during late follow up, defined as >8 years after the procedure. BackgroundEVAR is associated with reduced morbidity and mortality compared to open surgery in the early perioperative period. However, it is unknown whether this pattern remains during long-term follow up >8 years. MethodsA meta-analysis was conducted with the use of random effects modeling. Hazard ratios were calculated for mortality at different time intervals, and risk ratios were calculated in cases where the total number of events was available. ResultsThere was no difference in all-cause mortality during follow up of each study (HR: 1.04; 95%CI: 0.93–1.17; I2 = 16.0%). Subgroup analyses for all-cause mortality at 4 to 8 years of follow up (HR: 1.13; 95%CI: 0.94–1.35; I2 = 0.0%) and all-cause mortality at follow up >8 years (HR: 1.07; 95%CI: 0.89–0.28; I2 = 36.6%) also did not show any significant difference between the two approaches. The risks of aneurysm-related mortality and aneurysm rupture were similar during follow-up. However, the cumulative risk for reintervention during follow up was greater in the EVAR group (RR: 2.18; 95%CI: 1.50–3.17; I2 = 76.1%) and occurred in 29% vs 15% of patients in the EVAR vs surgery groups respectively. ConclusionsEVAR and open surgical repair of AAA are equally safe and have no difference in all-cause mortality. However, endovascular repair is associated with an increased need for re-intervention. Emerging technology in endovascular devices will likely further improve the outcomes of EVAR.Subject codes: Meta-analysis; aneurysm; atherosclerosis; complications.