What is the clinical evidence from this study?

Study design: Systematic Review. Population: Abdominal aortic aneurysms (n=1318). Intervention: Elective endovascular repair vs. Open surgical repair. Primary outcome: 30-day mortality (OR 0.55, 95% CI 0.33, 0.92, p=0.03).

September 1, 2002

Elective Endovascular versus Open Surgical Repair of Abdominal Aortic Aneurysms: Systematic Review of Short-term Results

Key Result

Elective endovascular repair of abdominal aortic aneurysms reduced 30-day mortality compared to open surgical repair (OR 0.55; 95% CI 0.33-0.92; P=0.03).

Study Design

Type

Systematic Review (n=1,318)

Structured PICO

Does elective endovascular repair reduce short-term mortality and complications compared to open surgical repair in patients with abdominal aortic aneurysms?

Population

Systematic review of 9 studies including 1,318 procedures comparing elective endovascular and open surgical repair of abdominal aortic aneurysms.

Intervention

Elective endovascular repair

Comparator

Open surgical repair

Outcome

Short-term results including 30-day mortality, local/vascular complications, systemic/remote complications, blood loss, and length of stayhard clinical

Elective endovascular repair of abdominal aortic aneurysms is associated with lower short-term mortality, less blood loss, shorter hospital stays, and fewer systemic complications compared to open surgical repair.

Main Result

Odds Ratio: 0.55 (95% CI 0.33–0.92)

Absolute Event Rate: 0.03% vs 0.04%

p-value: p=0.03

Abstract

PURPOSE: To summarize and compare published short-term results of elective endovascular and open surgical repair of abdominal aortic aneurysms. MATERIALS AND METHODS: A MEDLINE search of the English literature was performed. Studies with at least 10 patients in each treatment group were included if they reported patient characteristics, complications, and mortality. Two reviewers independently extracted the data. A random-effects model was used to pool the data and calculate pooled odds ratios (endovascular vs open surgical repair). RESULTS: Nine studies were included, reporting results of 1,318 procedures (687 endovascular repair and 631 open surgical repair). Mean blood loss was 456 mL for endovascular repair and 1,202 mL for open surgical repair (P =.003). On average, patients undergoing endovascular repair spent 0.5 days in the intensive care unit and 3.9 days in the hospital, and patients undergoing open surgical repair spent 2.2 days (P =.04) in the intensive care unit and 10.3 days (P =.02) in the hospital. The pooled 30-day-mortality was 0.03 for endovascular repair (95% CI: 0.02, 0.04) and 0.04 for open surgical repair (95% CI: 0.00, 0.07) (P =.03), and the odds ratio was 0.55 (95% CI: 0.33, 0.92). The pooled local and/or vascular complication rate was 0.16 for endovascular repair (95% CI: 0.06, 0.25) and 0.12 for open surgical repair (95% CI: 0.06, 0.18) (P =.46), and the odds ratio was 0.97 (95% CI: 0.62, 1.54). The pooled systemic and/or remote complication rate was 0.17 for endovascular repair (95% CI: 0.09, 0.25) and 0.44 for open surgical repair (95% CI: 0.21, 0.66) (P <.001), and the odds ratio was 0.22 (95% CI: 0.11, 0.45). CONCLUSION: On the basis of this systematic review, endovascular repair results in less blood loss, shorter intensive care unit and hospital stays, lower 30-day mortality, and lower systemic and/or remote complication rates than those of open surgical repair.

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