Emergent endovascular vs. open surgery repair for ruptured abdominal aortic aneurysms: a meta-analysis.
OBJECTIVE
To systematically review studies comparing peri-operative mortality and length of hospital stay in patients with ruptured abdominal aortic aneurysms (rAAAs) who underwent endovascular aneurysm repair (EVAR) to patients who underwent open surgical repair (OSR).


METHODS
The Medline, Cochrane, EMBASE, and Google Scholar databases were searched until Apr 30, 2013 using keywords such as abdominal aortic aneurysm, emergent, emergency, rupture, leaking, acute, endovascular, stent, graft, and endoscopic. The primary outcome was peri-operative mortality and the secondary outcome was length of hospital stay.


RESULTS
A total of 18 studies (2 randomized controlled trials, 5 prospective studies, and 11 retrospective studies) with a total of 135,734 rAAA patients were included. rAAA patients who underwent EVAR had significantly lower peri-operative mortality compared to those who underwent OSR (overall OR = 0.62, 95% CI = 0.58 to 0.67, P<0.001). rAAA patients with EVAR also had a significantly shorter mean length of hospital stay compared to those with OSR (difference in mean length of stay ranged from -2.00 to -19.10 days, with the overall estimate being -5.25 days (95% CI = -9.23 to -1.26, P = 0.010). There was no publication bias and sensitivity analysis showed good reliability.


CONCLUSIONS
EVAR confers significant benefits in terms of peri-operative mortality and length of hospital stay. There is a need for more randomized controlled trials to compare outcomes of EVAR and OSR for rAAA.
The Department of Cardiovascular Surgery, Xinqiao Hospital, the Third Military Medical University, Chongqing, PR China.
Chuan
C
Qin
The Department of Cardiovascular Surgery, Xinqiao Hospital, the Third Military Medical University, Chongqing, PR China.
Lin
L
Chen
The Department of Cardiovascular Surgery, Xinqiao Hospital, the Third Military Medical University, Chongqing, PR China.
Ying-bin
YB
Xiao
D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery; D001019:Aortic Rupture / Q000401:mortality / Q000601:surgery; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D016032:Randomized Controlled Trials as Topic