title: Percutaneous access for endovascular aortic aneurysm repair: A systematic review and meta-analysis.
abstract: OBJECTIVE
  Our objective was to undertake a comprehensive review of the literature and conduct an analysis of the outcomes of percutaneous endovascular aneurysm repair.
  
  
  METHODS
  MEDLINE; EMBASE; CINAHL; CENTRAL; the World Health Organization International Clinical Trials Registry; ClinicalTrials.gov; and ISRCTN Register, and bibliographic reference lists were searched to identify all studies providing comparative outcomes of the percutaneous technique for endovascular aneurysm repair. Success rate and access-related complications were defined as the primary outcome parameters. Combined overall effect sizes were calculated using fixed effect or random effects models. We conducted a network meta-analysis of different techniques for femoral access applying multivariate meta-analysis assuming consistency.
  
  
  RESULTS
  Three randomised controlled trials and 18 observational studies were identified. Percutaneous access was associated with a lower frequency of groin infection (p < 0.0001) and lymphocele (p = 0.007), and a shorter procedure time (p < 0.0001) and hospital length of stay (p = 0.03) compared with open surgical access. Moreover, percutaneous endovascular aneurysm repair did not increase the risk of haematoma, pseudoaneurysm, and arterial thrombosis or dissection.
  
  
  CONCLUSIONS
  Percutaneous access demonstrates advantages over conventional surgical exposure for endovascular aneurysm repair, as indicated by access-related complications and hospital length of stay. Further research is required to define its impact on resource utilization, cost-effectiveness and quality of life.
authors.affiliation: Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital & University Hospital Aintree, Liverpool, UK shahin_hajibandeh@yahoo.com.
authors.forename: Shahin
authors.initials: S
authors.lastname: Hajibandeh
authors.affiliation: Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital & University Hospital Aintree, Liverpool, UK.
authors.forename: Shahab
authors.initials: S
authors.lastname: Hajibandeh
authors.affiliation: Department of General Surgery, University Hospital of Heraklion, University of Crete, Heraklion, Greece.
authors.forename: Stavros A
authors.initials: SA
authors.lastname: Antoniou
authors.affiliation: Library Resource & Information Centre, University Hospital Aintree, Liverpool, UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Child
authors.affiliation: Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital & University Hospital Aintree, Liverpool, UK.
authors.forename: Francesco
authors.initials: F
authors.lastname: Torella
authors.affiliation: Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, The Pennine Acute Hospitals NHS Trust, Manchester, UK.
authors.forename: George A
authors.initials: GA
authors.lastname: Antoniou
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011677:Punctures; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Aortic aneurysm; EVAR; endovascular aneurysm repair; femoral cutdown; percutaneous access