title: Endovascular aortic aneurysm repair (EVAR) has significantly lower perioperative mortality in comparison to open repair: a systematic review.
abstract: OBJECTIVE
  The objective of this meta-analysis was to evaluate the effectiveness of endovascular abdominal aortic aneurysm repair (EVAR) in reducing inhospital mortality against open graft replacement for aortic aneurysm.
  
  
  METHODS
  Generic terms including EVAR, endovascular aneurysm repair and aortic endografting were used to search a variety of electronic databases. Based on selection criteria, decisions regarding inclusion and exclusion of primary studies were made.
  
  
  RESULTS
  A total of three randomized controlled trials on 1,468 patients were included. In the EVAR group, 12 of 759 (1.5%) patients died, compared to 33 of 709 (4.6%) patients who died in the open surgery group. In both the fixed and random effect models, EVAR was associated with statistically significantly lower perioperative mortality when compared to open surgical repair of aortic aneurysm. The risk ratio of 0.33 indicates that mortality is 3.3 times more likely in the open surgery group compared to the EVAR group.
  
  
  CONCLUSIONS
  EVAR carries a threefold lower risk of perioperative death in comparison to open repair of abdominal aortic aneurysm. This early advantage must be offset against the increased need for later re-intervention and probable equivalence of long-term outcome. In older and high operative risk patients, EVAR should be the treatment of choice.
authors.affiliation: Department of Vascular Surgery, Royal Free Hospital, Hampstead, London, UK. surgeon1wrh@hotmail.com
authors.forename: Muhammad S
authors.initials: MS
authors.lastname: Sajid
authors.forename: Mittal
authors.initials: M
authors.lastname: Desai
authors.forename: Zishan
authors.initials: Z
authors.lastname: Haider
authors.forename: Daryll M
authors.initials: DM
authors.lastname: Baker
authors.forename: George
authors.initials: G
authors.lastname: Hamilton
mesh_terms: D001014:Aortic Aneurysm / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D016017:Odds Ratio; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods* / Q000401:mortality*