title: Endovascular versus Open Surgery Repair of Ruptured Abdominal Aortic Aneurysms in Hemodynamically Unstable Patients: Literature Review and Meta-Analysis.
abstract: BACKGROUND
  The better outcome achieved by endovascular aortic repair (EVAR) in ruptured abdominal aortic aneurysm (rAAA) patients might derive from the fact that patients with hemodynamic instability preferentially underwent open repair. To further evaluate the effect of EVAR for rAAAs, a meta-analysis of studies in which hemodynamic instability was similar between the 2 treatment groups was conducted.
  
  
  METHODS
  MEDLINE, EMBASE, ISI Web of Knowledge, and the Cochrane Library were searched from January 2004 to May 2014 for randomized controlled trials (RCTs) and observational studies that compared EVAR with open surgery repair in rAAA patients.
  
  
  RESULTS
  Three RCTs and 10 observational studies covering 1,784 patients were included. Perioperative mortality occurred in 27.3% of the patients treated with EVAR and in 38.1% of the patients who underwent open repair. Subgroup analysis revealed consistent results in favor of EVAR in single-center, observational studies. Subgroup analysis and meta-regression analysis indicated that the superior effect of EVAR might be associated with more anatomically suitable patients in EVAR group.
  
  
  CONCLUSIONS
  The findings from our meta-analysis support EVAR in properly selective rAAA patients.
authors.affiliation: Division of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Yonghui
authors.initials: Y
authors.lastname: Li
authors.affiliation: Division of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Zilun
authors.initials: Z
authors.lastname: Li
authors.affiliation: Division of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Shenming
authors.initials: S
authors.lastname: Wang
authors.affiliation: Division of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Guangqi
authors.initials: G
authors.lastname: Chang
authors.affiliation: Division of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Ridong
authors.initials: R
authors.lastname: Wu
authors.affiliation: Division of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Zuojun
authors.initials: Z
authors.lastname: Hu
authors.affiliation: Division of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Henghui
authors.initials: H
authors.lastname: Yin
authors.affiliation: Division of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. Electronic address: wjpine@hotmail.com.
authors.forename: Jingsong
authors.initials: J
authors.lastname: Wang
authors.affiliation: Division of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. Electronic address: yaochen_sums@163.com.
authors.forename: Chen
authors.initials: C
authors.lastname: Yao
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D006439:Hemodynamics; D006801:Humans; D016017:Odds Ratio; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome