title: [Metaanalysis of EVAR versus open repair for patients undergoing elective repair of abdominal aortic aneurysms].
abstract: BACKGROUND
  Elective endovascular abdominal aneurysm repair (EVAR) has become established in the past 20 years as a therapy option for infrarenal abdominal aortic aneurysms (AAA). Even so the benefits of EVAR over open aneurysm repair (OR) are still being discussed controversially.
  
  
  METHODS
  A random effects meta-analysis model was used to compare the surgical outcome of EVAR with that of open operations. The end points were evaluated comparatively by use of the Peto odds ratio (Peto OR) and weighted mean differences (WMD). Four prospective randomised studies (EVAR-1, DREAM, OVER, ACE) with a total of 2747 patients (EVAR 1381, OR 1366) were included in the metaanalysis.
  
  
  RESULTS
  In comparison to OR, EVAR was associated with a significantly reduced 30-day mortality rate (Peto OR: 0.373; p<0.001). In addition, there was a statistically significant advantage of EVAR over OR with regard to aneurysm-associated mortality (Peto OR: 0.589, p=0.013) and the length of hospital stay (SD in mean: -0.494; p<0.001). In contrast OR exhibited a lower re-intervention rate than EVAR (Peto OR: 1.843, p<0.001). On consideration of long-term survival (Peto OR: 0,977; p=0.826) and health-related quality of life there were no statistically significant differences between the two therapeutic options (SD in mean: - 0.032, p=0.481).
  
  
  CONCLUSIONS
  In spite of the clinical heterogeneity of the studies included in the metaanalysis, the data indicate that EVAR has a marked benefit with regard to surgical mortality. In the long-term course this advantage in survival is lost but this is not due to the aneurysm-associated mortality.
authors.affiliation: Klinik und Poliklinik für Gefäßchirurgie, Uniklinik Köln, Köln, Deutschland.
authors.forename: T
authors.initials: T
authors.lastname: Lübke
authors.affiliation: Klinik und Poliklinik für Gefäßchirurgie, Uniklinik Köln, Köln, Deutschland.
authors.forename: J
authors.initials: J
authors.lastname: Brunkwall
mesh_terms: D001012:Aorta, Abdominal / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D057510:Endovascular Procedures; D005500:Follow-Up Studies; D006801:Humans; D011446:Prospective Studies; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate