title: Systematic review and meta-analysis of the early and late outcomes of open and endovascular repair of abdominal aortic aneurysm.
abstract: BACKGROUND
  Any possible long-term benefit from endovascular (EVAR) versus open surgical repair for abdominal aortic aneurysm (AAA) remains unproven. Long-term data from the Open Versus Endovascular Repair (OVER) trial add to the debate regarding long-term all-cause and aneurysm-related mortality. The aim of this study was to investigate 30-day and long-term mortality, reintervention, rupture and morbidity after EVAR and open repair for AAA in a systematic review.
  
  
  METHODS
  Standard PRISMA guidelines were followed. Random-effects Mantel-Haenszel meta-analysis was performed to evaluate mortality and morbidity outcomes.
  
  
  RESULTS
  The existing published randomized trials, together with information from Medicare and SwedVasc databases, were included in a meta-analysis. This included 25 078 patients undergoing EVAR and 27 142 undergoing open repair for AAA. Patients who had EVAR had a significantly lower 30-day or in-hospital mortality rate (1·3 per cent versus 4·7 per cent for open repair; odds ratio (OR) 0·36, 95 per cent confidence interval 0·21 to 0·61; P < 0·001). By 2-year follow-up there was no difference in all-cause mortality (14·3 versus 15·2 per cent; OR 0·87, 0·72 to 1·06; P = 0·17), which was maintained after at least 4 years of follow-up (34·7 versus 33·8 per cent; OR 1·11, 0·91 to 1·35; P = 0·30). There was no significant difference in aneurysm-related mortality by 2 years or longer follow-up. A significantly higher proportion of patients undergoing EVAR required reintervention (P = 0·003) and suffered aneurysm rupture (P < 0·001).
  
  
  CONCLUSIONS
  There is no long-term survival benefit for patients who have EVAR compared with open repair for AAA. There are also significantly higher risks of reintervention and aneurysm rupture after EVAR.
authors.affiliation: Vascular Surgery Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK. pws7@le.ac.uk
authors.forename: P W
authors.initials: PW
authors.lastname: Stather
authors.forename: D
authors.initials: D
authors.lastname: Sidloff
authors.forename: N
authors.initials: N
authors.lastname: Dattani
authors.forename: E
authors.initials: E
authors.lastname: Choke
authors.forename: M J
authors.initials: MJ
authors.lastname: Bown
authors.forename: R D
authors.initials: RD
authors.lastname: Sayers
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000401:mortality / Q000601:surgery*; D057510:Endovascular Procedures / Q000379:methods* / Q000401:mortality; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D016032:Randomized Controlled Trials as Topic; D012086:Reoperation; D016019:Survival Analysis; D016896:Treatment Outcome