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
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; ; ). 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; ) in favor of EVAR. The average LOS was reduced by 296.75？hrs (95% CI 156.68–436.82？hrs; ) 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. 1. Background Abdominal aortic aneurysm (AAA) is a prevalent threat, affecting approximately 5% of males over the age of 65. Open aneurysm repair (OAR) has been performed since the 1950s with a 30-day mortality of 4–12% [1]. 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 1-2% [2]. Subsequent long-term follow-up data from both the EVAR 1 trial group as well as the DREAM trial suggested the mortality curves become equivalent as early as 1 year [3, 4]. Previous meta-analysis looked to address the 30-day mortality rates based on age and surgical experience as well as defining operative complications. We performed a systemic review of the literature to analyze the rates of 30-day mortality, 30-day myocardial infarction, and hospital length of stay based on comparative observation and randomized control trials involving endovascular and open approach to elective and ruptured AAA repair. 2. Methods 2.1. Data Sources and Study Selection Two reviewers independently conducted the literature search and extraction of relevant articles from MEDLINE database, Embasse database, and Cochrane library for English language studies in humans older than 18 years of age. The date of the last search was obtained on July 1, 2012. We used the text words and related Medical Subject Headings terms: EVAR, outcome, mortality, morbidity, and endovascular aortic repair. We also searched
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