Open versus Endovascular Repair of Abdominal Aortic Aneurysm in the Elective and Emergent Setting in a Pooled Population of 37,781 Patients: A Systematic Review and Meta-Analysis.

Dustin M Thomas,David M F Anderson,Fiora Mcrae,Nathan Anderson,Todd C Villines,Shane T Ellis,Ahmad M Slim,Jamil A Malik,Edward A Hulten

doi:10.1155/2014/149243

Abstract

Background. We evaluated the incidence of mortality and myocardial infarction (MI) in endovascular repair (EVAR) as compared to open aneurysm repair (OAR) in both elective and ruptured abdominal aortic aneurysm (AAA ) setting. Methods. We analyzed the rates of 30-day mortality, 30-day MI, and hospital length of stay (LOS) based on comparative observation and randomized control trials involving EVAR and OAR. Results. 41 trials compared EVAR to OAR with a total pooled population of 37,781 patients. Analysis of elective and ruptured AAA repair favored EVAR with respect to 30-day mortality with a pooled odds ratio of 0.19 (95% CI 0.17–0.20; I 2 = 88.9%; P < 0.001). There were a total of 1,835 30-day MI events reported in the EVAR group as compared to 2,483 events in the OAR group. The pooled odds ratio for elective AAA was 0.74 (95% CI 0.58–0.96; P = 0.02) in favor of EVAR. The average LOS was reduced by 296.75 hrs (95% CI 156.68–436.82 hrs; P < 0.001) in the EVAR population. Conclusions. EVAR has lower rates of 30-day mortality, 30-day MI, and LOS in both elective and ruptured AAA repair.

Highlights

We evaluated the incidence of mortality and myocardial infarction (MI) in endovascular repair (EVAR) as compared to open aneurysm repair (OAR) in both elective and ruptured abdominal aortic aneurysm (AAA ) setting
In this study of pooled population of 37,781 patients with known AAA who underwent either EVAR or OAR in both the elective as well as the ruptured setting, EVAR appears to be favored with lower rates of 30-day mortality and average hospital length of stay and myocardial infarction that is potentially associated with significant cost reduction without compromising outcomes
In a similar meta-analysis performed by Lovegrove et al of 21,178 patients who underwent either EVAR or OAR for elective AAA repair, EVAR was associated with shorter intensive care unit, total hospital stay, less cardiac and respiratory complications, and lower mortality rates [51]

Summary

Introduction

We evaluated the incidence of mortality and myocardial infarction (MI) in endovascular repair (EVAR) as compared to open aneurysm repair (OAR) in both elective and ruptured abdominal aortic aneurysm (AAA ) setting. Analysis of elective and ruptured AAA repair favored EVAR with respect to 30-day mortality with a pooled odds ratio of 0.19 (95% CI 0.17–0.20; I2 = 88.9%; P < 0.001). EVAR has lower rates of 30-day mortality, 30-day MI, and LOS in both elective and ruptured AAA repair. Since the early 1990s, endovascular repair (EVAR) of both elective and ruptured AAA has steadily increased. This was driven predominantly by early data reporting lower 30-day mortality rates of 12% [2].

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Results

Conclusion