title: Open repair versus fenestrated endovascular aneurysm repair of juxtarenal aneurysms.
abstract: BACKGROUND
  Open repair is the gold standard management for juxtarenal aneurysms. Fenestrated endovascular aneurysm repair (FEVAR) is indicated for high-risk patients. The long-term outcomes of FEVAR are largely unknown, and there is no Level I comparative evidence. This systematic review and meta-analysis of case series compares elective juxtarenal aneurysm surgery by open repair and FEVAR.
  
  
  METHODS
  A systematic literature search was conducted for all published studies on elective repair of juxtarenal aneurysms by FEVAR and open repair. The MEDLINE, EMBASE, and Cochrane databases were searched from 1947 to April 2013. The exclusion criteria were case series of <10 patients or ruptured aneurysms. The primary outcomes were perioperative mortality and postoperative renal insufficiency. The secondary outcomes were secondary reinterventions and long-term survival.
  
  
  RESULTS
  We identified 35 case series with data on 2326 patients. Perioperative mortality was 4.1% in open repair and FEVAR case series (odds ratio for open repair with FEVAR, 1.059; 95% confidence interval, 0.642-1.747; P = .822). Postoperative renal insufficiency was not significantly different (odds ratio for open repair with FEVAR, 1.136; 95% confidence interval, 0.754-1.713; P = .542). FEVAR patients had higher rates of secondary reintervention, renal impairment during follow-up, and a lower long-term survival compared with open repair patients.
  
  
  CONCLUSIONS
  FEVAR and open repair have similar short-term outcomes but have diverging long-term outcomes that may be secondary to the selection bias of FEVAR being offered to high-risk patients. FEVAR is a favorable option in high-risk patients, and open repair remains viable as the gold standard.
authors.affiliation: Academic Section of Vascular Surgery, Division of Surgery, Department of Surgery & Cancer, Imperial College London, Charing Cross Hospital, London, United Kingdom. Electronic address: rohinirao91@gmail.com.
authors.forename: Rohini
authors.initials: R
authors.lastname: Rao
authors.affiliation: Academic Section of Vascular Surgery, Division of Surgery, Department of Surgery & Cancer, Imperial College London, Charing Cross Hospital, London, United Kingdom.
authors.forename: Tristan R A
authors.initials: TR
authors.lastname: Lane
authors.affiliation: Academic Section of Vascular Surgery, Division of Surgery, Department of Surgery & Cancer, Imperial College London, Charing Cross Hospital, London, United Kingdom.
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Franklin
authors.affiliation: Academic Section of Vascular Surgery, Division of Surgery, Department of Surgery & Cancer, Imperial College London, Charing Cross Hospital, London, United Kingdom.
authors.forename: Alun H
authors.initials: AH
authors.lastname: Davies
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D016009:Chi-Square Distribution; D017558:Elective Surgical Procedures; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016017:Odds Ratio; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D011474:Prosthesis Design; D012086:Reoperation; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome