Open versus endovascular stent graft repair of abdominal aortic aneurysms: a meta-analysis of randomized trials.
OBJECTIVE
This study sought to evaluate the short-, intermediate-, and longer-term outcomes after endovascular versus open repair of abdominal aortic aneurysms (AAA), including both AAA-related and all-cause mortality.


BACKGROUND
Endovascular stent graft placement for AAA has gained broad acceptance as an alternative to open surgical repair due to a lower perioperative morbidity and mortality. The intermediate- and long-term all-cause and aneurysm-related mortality vary among studies. Thus, we sought to perform a meta-analysis of open versus endovascular repair for treating AAA.


METHODS
Electronic databases were queried for identification of prospective, randomized trials of open surgery versus endovascular stent graft repair of AAA. A total of 10 published papers reporting on 6 studies at different follow-up intervals were identified; they involved 2,899 patients with AAA repair procedures, of whom, 1,470 underwent endovascular stent graft AAA exclusion and 1,429 were treated by open AAA repair.


RESULTS
At 30 days, the pooled relative risk of all-cause mortality was lower in the endovascular group (relative risk [RR]: 0.35, 95% confidence interval [CI]: 0.19 to 0.64) than in the open surgery group. At intermediate follow-up, the all-cause mortality had a nonsignificant difference (RR: 0.78, 95% CI: 0.57 to 1.08), the AAA-related mortality was significantly lower (RR: 0.46, 95% CI: 0.28 to 0.74) and reintervention rates were higher (RR: 1.48, 95% CI: 1.06 to 2.08) in the endovascular group than in the open surgery group. At long-term follow-up, there was no significant difference in all-cause mortality (RR: 0.99, 95% CI: 0.85 to 1.15) or AAA-related mortality (RR: 1.58, 95% CI: 0.20 to 12.74), whereas the significant difference in the rate of reinterventions persisted (RR: 2.54, 95% CI: 1.58 to 4.08).


CONCLUSIONS
In patients randomized to open or endovascular AAA repair, all-cause perioperative mortality, as well as AAA-related mortality at short- and intermediate-term follow-up are lower in patients undergoing endovascular stent graft placement. This was associated with greater reintervention in the endovascular group noted at intermediate follow-up. Long-term survival appears to converge between the 2 groups.
Division of Cardiology, Mount Sinai Medical Center, New York, NY 10029, USA. george.dangas@mountsinai.org
George
G
Dangas
David
D
O'Connor
Belal
B
Firwana
Somjot
S
Brar
Sharif
S
Ellozy
Angeliki
A
Vouyouka
Margaret
M
Arnold
Constantine E
CE
Kosmas
Prakash
P
Krishnan
Jose
J
Wiley
Javed
J
Suleman
Jeffrey
J
Olin
Michael
M
Marin
Peter
P
Faries
D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D016001:Confidence Intervals; D057510:Endovascular Procedures / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D012306:Risk; D015607:Stents; D016896:Treatment Outcome; D014481:United States