Open repair, endovascular repair, and conservative management of true splenic artery aneurysms

Abstract

EV of SAA has better short-term results compared with OPEN, including significantly lower perioperative mortality. OPEN is associated with fewer late complications and fewer reinterventions during follow-up. Patients treated with CONS showed a higher late mortality rate. Ruptured SAAs are predictors of a significantly higher perioperative mortality compared with nonruptured SAAs in the OPEN and EV groups.

Cost-effectiveness of endovascular repair, open repair, and conservative management of splenic artery aneurysms

“…Most of the input variables were retrieved from a recent and extensive meta-analysis of the three major treatment options for patients with SAAs. 6 Input probabilities required for the model but not reported in the meta-analysis were retrieved from articles reporting the necessary probabilities. For example, the risk of infection, overwhelming postsplenectomy infection, percentage that required hospitalization, and mortality rate were extracted from studies reporting these outcomes.…”

“…The prevalence of diabetes is 15% in patients with AAA vs 12% in patients with SAAs, and the prevalence is 13% vs 16% for coronary artery disease and 65% vs 48% for hypertension. 6,15 The mortality rates were tested over a wide range, including the mortality rate for AAA patients, to take the uncertainty around these mortality rates into account.…”

“…We chose 55-year-old female patients because this is the average age of diagnosis and most patients with SAAs are women. 6 The primary outcomes of the analysis of the model were mean QALYs and costs. Subsequently, costeffectiveness was determined by first considering dominance (higher effectiveness and lower costs) and for nondominant strategies by calculating the incremental costeffectiveness ratio (ICER ¼ difference in costs/difference in effectiveness).…”

“…Endovascular repair (EV) of SAAs has been increasingly used since 2000, and a recent extensive meta-analysis reported superior short-term outcomes for EV compared with OPEN. 6 However, considering the better long-term results of OPEN compared with EV and CONS shown in the meta-analysis, the preferred treatment option for patients with a SAA is still matter of debate, and no clear treatment guidelines exist. In addition, EV is usually accompanied by higher intervention costs and more reinterventions.…”

“…In addition, EV is usually accompanied by higher intervention costs and more reinterventions. 6 Thus, the treatment of a patient with an SAA is not a straightforward decision. Importantly, a contemplated decision should not only be based on the expected mortality and complications but should also account for quality of life (QOL), associated interventional and lifetime costs, and expected reinterventions.…”