title: Ruptured Aneurysm Trials: The Importance of Longer-term Outcomes and Meta-analysis for 1-year Mortality.
abstract: OBJECTIVE
  To assess current knowledge for the management of ruptured abdominal aortic aneurysm (AAA), based on the 1-year outcomes of 3 recent randomised trials.
  
  
  METHODS
  An individual patient data meta-analysis of three recent randomised trials of endovascular versus open repair, including 817 patients, was conducted according to a pre-specified analysis plan, report all-cause mortality and re-interventions at 1 year after the index event.
  
  
  RESULTS
  Mortality across the 3 trials at 1-year was 38.6% for the EVAR or endovascular strategy patient groups and 42.8% for the open repair groups, pooled odds ratio 0.84 (95% CI 0.63-1.11), p = .209. There was no evidence of heterogeneity in the odds ratios between trials. When the patients in the endovascular strategy group of the IMPROVE trial were restricted to those with proven rupture who were anatomically suitable for endovascular repair, the pooled odds ratio reduced slightly to 0.80 (95% CI 0.56-1.16), p = .240.
  
  
  CONCLUSIONS
  After 1 year there is a consistent but non-significant trend for lower mortality for EVAR or an endovascular strategy. Taken together with the recent gains in health economic outcomes demonstrated at 1 year in the IMPROVE trial, the evidence suggests that endovascular repair should be used more widely for ruptured aneurysms.
authors.affiliation: Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
authors.forename: M J
authors.initials: MJ
authors.lastname: Sweeting
authors.affiliation: Vascular Surgery Research Group, Imperial College, Charing Cross Hospital, Fulham Palace Road, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Ulug
authors.affiliation: Vascular Surgery Research Group, Imperial College, Charing Cross Hospital, Fulham Palace Road, London, UK. Electronic address: j.powell@imperial.ac.uk.
authors.forename: J T
authors.initials: JT
authors.lastname: Powell
authors.affiliation: Vascular Surgery Unit, Hospital Henri Mondor, Creteil, France.
authors.forename: P
authors.initials: P
authors.lastname: Desgranges
authors.affiliation: Department of Vascular Surgery, Academic Medical Centre, Amsterdam, Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Balm
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D001019:Aortic Rupture / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016017:Odds Ratio; D018579:Patient Selection; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Meta-analysis; Ruptured abdominal aortic aneurysm