- Endovascular aneurysm repair (EVAR) vs open surgical repair (OSR) is associated with higher long-term (5-9 years) all-cause mortality, reintervention, and secondary rupture rates.
- In the very long term (≥10 years), EVAR is associated with higher reintervention and secondary rupture rates; no difference in very long-term mortality was observed between groups.
Why this matters
- Studies demonstrating long-term outcomes of EVAR vs OSR have shown conflicting results.
- Guidelines continue to recommend EVAR over OSR for anatomically suitable patients.
- Meta-analysis of 3 randomised controlled trials and 68 observational studies comparing 151,092 EVAR to 148,692 OSR patients.
- Funding: None.
- For long-term outcomes (5-9 years), EVAR vs OSR was associated with higher:
- all-cause mortality, 27.3% vs 24.7% (OR, 1.19; 95% CI, 1.06-1.33; P=.003; I2=91%);
- reintervention, 17.6% vs 14.9% (OR, 2.12; 95% CI, 1.67-2.69; P <.00001 i>2=96%);
- secondary rupture rates, 2.0% vs 0.6% (OR, 4.84; 95% CI, 2.63-8.89; P<.00001 i>2=92%).
- For very long-term outcomes (≥10 years), EVAR vs OSR was associated with higher:
- reintervention, 20.9% vs 12.3% (OR, 2.47; 95% CI, 1.71-3.57; P<.00001 i>2=84%); and
- secondary rupture rates (OR, 8.10; 95% CI, 1.01-64.99; P=.05).
- No mortality difference was observed between EVAR vs OSR for very long-term outcomes (≥10 years) (OR, 0.92; 95% CI, 0.76-1.11; P=.39; I2=89%).
- Heterogeneity among studies.
- Publication bias.
- Selection bias.