A systematic review and meta-analysis of endovascular repair (EVAR) for ruptured abdominal aortic aneurysm.
BACKGROUND
Endovascular abdominal aortic aneurysm (EVAR) repair has become a well-established technique in the treatment of elective abdominal aortic aneurysms (AAAs) due to proven benefits in mortality, hospital stay and operation time compared to open repair. The aim of this study was to estimate the mortality rate from EVAR due to ruptured abdominal aortic aneurysm (RAAA).


METHODS
A systematic review and meta-analysis of all English language literature with information on mortality rates from EVAR for RAAA was conducted.


RESULTS
The pooled mortality rate from RAAA after EVAR across 31 studies concerning 982 patients was 24% (95% confidence interval (CI) 20-28%). The pooled morbidity from 21 studies was 44% (95% CI 33-55%). The average procedure time was 155.1 min, with an intra-operative blood loss of 523 ml and hospital stay of 10.1 days. There is evidence of publication bias suggesting the mortality rate may be under-estimated.


CONCLUSIONS
Mortality from EVAR for RAAA appears to be lower than that which is reported for open repair of RAAA. However, the high level of publication bias cannot be ignored and may actually indicate higher mortality rates.
Rayt
H S
HS
Department of Cardiovascular Sciences, Vascular Surgery Research Group, University of Leicester, Leicester Royal Infirmary, Leicester LE2 7LX, UK. hsrayt@hotmail.com
Sutton
A J
AJ
London
N J M
NJ
Sayers
R D
RD
Bown
M J
MJ
D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000401:mortality / Q000601:surgery*; D016063:Blood Loss, Surgical; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality*; D006801:Humans; D007902:Length of Stay; D017594:Publication Bias; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome