A comparison of endovascular versus open repair for ruptured abdominal aortic aneurysm – Meta-analysis of propensity score-matched data

Abstract

Background Optimal management of ruptured abdominal aortic aneurysms (rAAA) has been heavily debated in the literature. The aim of this review is to assess comparative outcomes from propensity-matched studies of endovascular versus open for rAAA. Methods Electronic databases (MEDLINE and Embase) were searched in January 2021 using the Healthcare Databases Advanced Search interface. Eligible studies compared endovascular versus open repair for rAAA using propensity-matched cohorts. Pooled estimates of perioperative outcomes were calculated using odds ratio (OR) or mean difference (MD) and 95% confidence interval (CI) using the random-effects model. Time-to-event data meta-analysis was conducted using the inverse-variance method and reported as summary hazard ratio (HR) and associated 95% CI. The quality of evidence was graded using a system developed by the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) working group. Results Six studies published between 2010 and 2020 were selected for qualitative and quantitative synthesis, reporting a total of 6731 patients. The odds of perioperative mortality after endovascular aneurysm repair (EVAR) were significantly lower than after open surgical repair (OSR) (OR 0.52, 95% CI 0.41–0.65). The hazard of overall mortality during follow-up was lower, although not significantly, after EVAR than after OSR (HR 0.79, 95% CI 0.62–1.01). The odds of acute kidney injury and early aneurysm-related reintervention were both significantly lower after EVAR than after OSR (OR 0.34, 95% CI 0.14–0.78 and OR 0.57, 95% CI 0.33–0.98, respectively). Patients treated with EVAR stayed in hospital for significantly less time than those treated with OSR (MD −5.13, 95% CI −7.94 to −2.32). The certainty of the body of evidence for perioperative mortality was low and for overall mortality was very low. Conclusion The evidence suggests that EVAR confers a significant benefit on perioperative mortality.

The Comparison of Endovascular and Open Surgical Treatment for Ruptured Abdominal Aortic Aneurysm in Terms of Safety and Efficacy on the Basis of a Single-Center 30-Year Experience

“…Of note, the early survival advantage of EVAR vs. OR may be pronounced in haemodynamically unstable rAAA patients [14]. A more recent meta-analysis that included almost 7000 patients reported similar findings, with a lower perioperative mortality after EVAR, although the hazard of overall mortality during follow-up was lower [15].…”

Impact of an emergency endovascular aneurysm repair protocol on 30-day ruptured abdominal aortic aneurysm mortality

“…The literature has shown that patients with an rAAA who undergo EVAR have shorter hospital and ICU stays compared with open repair, and our data demonstrated a similar trend. 13,[40][41][42][43][44] However, both hospital and ICU length of stay increased overall for the postprotocol population. Although we anticipated the length of hospital stay and length of ICU stay to decrease after the introduction of the emergency EVAR protocol, 45 this finding may reflect increased instability and comorbidity of patients in the postprotocol period.…”

Urgent and emergent repair of complex aortic aneurysms using an off-the-shelf branched device

“…Endovascular management of ruptured AAA have demonstrated improved outcomes during last decade, showing that early mortality in ruptured AAA cases is estimated at 20% ( 34 – 36 ). Compared to standard endovascular repair for ruptured AAA and taking into consideration that 45% of patients in the current study were managed for extensive type I–III TAAAs, the early mortality could be considered acceptable both for urgent and emergent repair.…”