Abdominal aortic aneurysm: long-term outcomes of endovascular vs open surgical repair

  • Li B & al.
  • J Vasc Surg
  • 27 May 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • 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.

Study design

  • Meta-analysis of 3 randomised controlled trials and 68 observational studies comparing 151,092 EVAR to 148,692 OSR patients.
  • Funding: None.

Key results

  • 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%).

Limitations

  • Heterogeneity among studies.
  • Publication bias.
  • Selection bias.