Elective endovascular versus open surgical repair of abdominal aortic aneurysms: systematic review of short-term results.
OBJECTIVE
To summarize and compare published short-term results of elective endovascular and open surgical repair of abdominal aortic aneurysms.


METHODS
A MEDLINE search of the English literature was performed. Studies with at least 10 patients in each treatment group were included if they reported patient characteristics, complications, and mortality. Two reviewers independently extracted the data. A random-effects model was used to pool the data and calculate pooled odds ratios (endovascular vs open surgical repair).


RESULTS
Nine studies were included, reporting results of 1,318 procedures (687 endovascular repair and 631 open surgical repair). Mean blood loss was 456 mL for endovascular repair and 1,202 mL for open surgical repair (P =.003). On average, patients undergoing endovascular repair spent 0.5 days in the intensive care unit and 3.9 days in the hospital, and patients undergoing open surgical repair spent 2.2 days (P =.04) in the intensive care unit and 10.3 days (P =.02) in the hospital. The pooled 30-day-mortality was 0.03 for endovascular repair (95% CI: 0.02, 0.04) and 0.04 for open surgical repair (95% CI: 0.00, 0.07) (P =.03), and the odds ratio was 0.55 (95% CI: 0.33, 0.92). The pooled local and/or vascular complication rate was 0.16 for endovascular repair (95% CI: 0.06, 0.25) and 0.12 for open surgical repair (95% CI: 0.06, 0.18) (P =.46), and the odds ratio was 0.97 (95% CI: 0.62, 1.54). The pooled systemic and/or remote complication rate was 0.17 for endovascular repair (95% CI: 0.09, 0.25) and 0.44 for open surgical repair (95% CI: 0.21, 0.66) (P <.001), and the odds ratio was 0.22 (95% CI: 0.11, 0.45).


CONCLUSIONS
On the basis of this systematic review, endovascular repair results in less blood loss, shorter intensive care unit and hospital stays, lower 30-day mortality, and lower systemic and/or remote complication rates than those of open surgical repair.
Dept of Radiology, Massachusetts General Hospital, Harvard Medical School, Zero Emerson Pl, Ste 2H, Boston 02114, USA.
Miraude E A P M
ME
Adriaensen
Johanna L
JL
Bosch
Elkan F
EF
Halpern
M G
MG
Myriam Hunink
G Scott
GS
Gazelle
D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D016063:Blood Loss, Surgical / Q000517:prevention & control; D017558:Elective Surgical Procedures; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay; D016017:Odds Ratio; D011183:Postoperative Complications; D014656:Vascular Surgical Procedures / Q000379:methods*