title: Worse late-phase survival after elective endovascular than open surgical repair for intact abdominal aortic aneurysm.
abstract: OBJECTIVE
  To determine whether follow-up survival is better after elective endovascular aneurysm repair (EVAR) than open surgical repair (OSR) for intact abdominal aortic aneurysm (AAA), we combined 5-year survival curves themselves of EVAR and OSR in randomized controlled trials (RCTs) and propensity-score matched (PSM) studies.
  
  
  METHODS
  Eligible studies were RCTs or PSM studies of elective EVAR versus OSR enrolling patients with intact AAA and reporting 5-year (at least) survival curves. Data regarding detailed inclusion criteria, duration of follow-up, and survival curves were abstracted from each individual study. In case of crossing of the combined survival curves, a pooled late-phase (between the crossing time and 5years) hazard ratio (HR) for all-cause mortality was calculated.
  
  
  RESULTS
  Our search identified 7 eligible studies (including 2 RCTs and 5 PSM studies) enrolling a total of 92,333 patients with AAA assigned to EVAR or OSR. Pooled survival rates after EVAR and OSR were 98.1% and 96.1 at 1month, 94.2% and 93.1% at 1year, 85.1% and 86.8% at 3years, and 75.8% and 78.8% at 5years, respectively. The survival curves crossed at 1.8years with the survival rate of 90.5%. A pooled late-phase (between 1.8years and 5years) HR for calculated from data of the combined survival curves significantly favored OSR (1.29, 95% confidence interval, 1.24 to 1.35; p<0.00001).
  
  
  CONCLUSIONS
  For intact AAA, although survival was better immediately after elective EVAR than OSR, the survival curves crossed at 1.8years. Thereafter until 5years, survival was worse after EVAR than OSR.
authors.affiliation: Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan. Electronic address: kfgth973@ybb.ne.jp.
authors.forename: Hisato
authors.initials: H
authors.lastname: Takagi
authors.affiliation: Department of Cardiology, Detroit Medical Center, Detroit, MI, United States.
authors.forename: Tomo
authors.initials: T
authors.lastname: Ando
authors.affiliation: Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Umemoto
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000401:mortality* / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000401:mortality* / Q000639:trends; D057510:Endovascular Procedures / Q000401:mortality* / Q000639:trends; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate / Q000639:trends
keywords: Abdominal aortic aneurysm; Endovascular aneurysm repair; Meta-analysis; Survival