title: Endovascular repair or open repair for ruptured abdominal aortic aneurysm: a Cochrane systematic review.
abstract: OBJECTIVE
  Emergency endovascular aneurysm repair (eEVAR) may improve outcomes for patients with ruptured abdominal aortic aneurysm (RAAA). The study aim was to compare the outcomes for eEVAR with conventional open surgical repair for the treatment of RAAA.
  
  
  METHODS
  A systematic review of relevant publications was performed. Randomised controlled trials (RCTs) comparing eEVAR with open surgical repair for RAAA were included.
  
  
  METHODS
  3 RCTs were included, with a total of 761 patients with RAAA.
  
  
  METHODS
  Meta-analysis was performed with fixed-effects models with ORs and 95% CIs for dichotomous data and mean differences with 95% CIs for continuous data.
  
  
  METHODS
  Primary outcome was short-term mortality. Secondary outcome measures included aneurysm-specific and general complication rates, quality of life and economic analysis.
  
  
  RESULTS
  Overall risk of bias was low. There was no difference between the 2 interventions on 30-day (or in-hospital) mortality, OR 0.91 (95% CI 0.67 to 1.22; p=0.52). 30-day complications included myocardial infarction, stroke, composite cardiac complications, renal complications, severe bowel ischaemia, spinal cord ischaemia, reoperation, amputation and respiratory failure. Reporting was incomplete, and no robust conclusion was drawn. For complication outcomes that did include at least 2 studies in the meta-analysis, there was no clear evidence to support a difference between eEVAR and open repair. Longer term outcomes and cost per patient were evaluated in only a single study, thus precluding definite conclusions.
  
  
  CONCLUSIONS
  Outcomes between eEVAR and open repair, specifically 30-day mortality, are similar. However, further high-quality trials are required, as the paucity of data currently limits the conclusions.
authors.affiliation: Mater Misericordiae University Hospital, Dublin, Ireland.
authors.forename: S A
authors.initials: SA
authors.lastname: Badger
authors.affiliation: Belfast Vascular Centre, Royal Victoria Hospital, Belfast, UK.
authors.forename: D W
authors.initials: DW
authors.lastname: Harkin
authors.affiliation: Belfast Vascular Centre, Royal Victoria Hospital, Belfast, UK.
authors.forename: P H
authors.initials: PH
authors.lastname: Blair
authors.affiliation: Belfast Vascular Centre, Royal Victoria Hospital, Belfast, UK.
authors.forename: P K
authors.initials: PK
authors.lastname: Ellis
authors.affiliation: Centre for Public Health, Queens University Belfast, Belfast, UK.
authors.forename: F
authors.initials: F
authors.lastname: Kee
authors.affiliation: Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
authors.forename: R
authors.initials: R
authors.lastname: Forster
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001019:Aortic Rupture / Q000601:surgery*; D057510:Endovascular Procedures / Q000379:methods* / Q000706:statistics & numerical data; D016896:Treatment Outcome