Abstract
BackgroundJuxtarenal abdominal aortic aneurysms pose a significant challenge whether managed endovascularly or by open surgery. Fenestrated endovascular aneurysm repair (FEVAR) is now well established, but few studies have compared it with open surgical repair (OSR). The aim of this systematic review was to compare short‐ and long‐term outcomes of FEVAR and OSR for the management of juxtarenal aortic aneurysms.MethodsA literature search was conducted of the Ovid Medline, EMBASE and PubMed databases. Reasons for exclusion were series with fewer than 20 patients, studies published before 2007 and those concerning ruptured aneurysms. Owing to variance in definitions, the terms ‘juxta/para/suprarenal’ were used; thoracoabdominal aortic aneurysms were excluded. Primary outcomes were 30‐day/in‐hospital mortality and renal insufficiency. Secondary outcomes included major complication rates, rate of reintervention and rates of endoleak.ResultsTwenty‐seven studies were identified, involving 2974 patients. Study designs included 11 case series, 14 series within retrospective cohort studies, one case–control study and a single prospective non‐randomized trial. The pooled early postoperative mortality rate following FEVAR was 3·3 (95 per cent c.i. 2·0 to 5·0) per cent, compared with 4·2 (2·9 to 5·7) per cent after OSR. After FEVAR, the rate of postoperative renal insufficiency was 16·2 (10·4 to 23·0) per cent, compared with 23·8 (15·2 to 33·6) per cent after OSR. The major early complication rate following FEVAR was 23·1 (16·8 to 30·1) per cent versus 43·5 (34·4 to 52·8) per cent after OSR. The rate of late reintervention after FEVAR was higher than that after OSR: 11·1 (6·7 to 16·4) versus 2·0 (0·6 to 4·3) per cent respectively.ConclusionNo significant difference was noted in 30‐day mortality; however, FEVAR was associated with significantly lower morbidity than OSR. Long‐term durability is a concern, with far higher reintervention rates after FEVAR.
Highlights
Abdominal aortic aneurysms (AAAs) involving, or in close proximity to, the renal arteries pose a significant challenge during both open surgical repair (OSR) and endovascular aneurysm repair (EVAR)[1]
The literature search identified 1547 potential articles. Following assessment this was refined to 27 studies, 14 involving Fenestrated endovascular aneurysm repair (FEVAR) and 13 involving OSR, which were analysed using qualitative and quantitative methods
RCTs10,37 have shown that the early safety profile of EVAR is better than that of OSR in the treatment of infrarenal AAA
Summary
Juxtarenal abdominal aortic aneurysms pose a significant challenge whether managed endovascularly or by open surgery. Fenestrated endovascular aneurysm repair (FEVAR) is well established, but few studies have compared it with open surgical repair (OSR). The aim of this systematic review was to compare short- and long-term outcomes of FEVAR and OSR for the management of juxtarenal aortic aneurysms. The pooled early postoperative mortality rate following FEVAR was 3⋅3 (95 per cent c.i. 2⋅0 to 5⋅0) per cent, compared with 4⋅2 (2⋅9 to 5⋅7) per cent after OSR. After FEVAR, the rate of postoperative renal insufficiency was 16⋅2 (10⋅4 to 23⋅0) per cent, compared with 23⋅8 (15⋅2 to 33⋅6) per cent after OSR. The major early complication rate following FEVAR was 23⋅1 (16⋅8 to 30⋅1) per cent versus 43⋅5 (34⋅4 to 52⋅8) per cent after OSR. Long-term durability is a concern, with far higher reintervention rates after FEVAR.
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