Endovascular aneurysm repair showed no difference in overall survival compared to open surgical repair in patients with intact abdominal aortic aneurysm (HR 1.02, 95% CI 0.93 to 1.12).
Systematic Review (n=2,790)
Yes
Does endovascular aneurysm repair improve overall survival or reduce reintervention compared to open surgical repair in adult patients with intact abdominal aortic aneurysm?
In patients with intact abdominal aortic aneurysm, EVAR does not improve overall survival compared to open surgical repair and is associated with a higher risk of reintervention.
Effect estimate: HR 1.02 (95% CI 0.93 to 1.12)
Abstract Background A few randomized controlled trials (RCTs) have investigated endovascular aneurysm repair (EVAR) and open surgical repair (OSR) in patients with intact aortic abdominal aneurysm (AAA). Objective We aimed to evaluate the efficacy of EVAR vs OSR in patients with intact AAA. Methods We included RCTs and searched MEDLINE and the Cochrane Library on 28 December 2024 without limits. The beneficial primary outcome was overall survival, and the adverse primary outcome was reintervention. In both cases, the outcome measure was the hazard ratio (HR). Two people independently selected studies and extracted data. Management of missing data included deducing time-to-event data from published survival curves and contacting study authors. Results We retrieved 723 references from electronic databases and additional sources and included four RCTs. The pooled HR on overall survival favors neither EVAR nor OSR (HR = 1.02 95% CI 0.93 to 1.12), but the pooled HR on reintervention favors OSR (HR = 2.14 95% CI 1.70 to 2.70). Statistical heterogeneity was low, and the risk of bias had no noteworthy impact on the results. Conclusions Pooled data from four randomized controlled trials on intact aortic abdominal aneurysm favor not EVAR regarding overall survival but favor OSR with respect to reintervention. Systematic review registration PROSPERO CRD42024539841
Peinemann et al. (Fri,) conducted a systematic review in intact abdominal aortic aneurysm (n=2,790). endovascular aneurysm repair (EVAR) vs. open surgical repair (OSR) was evaluated on overall survival (death from any cause) (HR 1.02, 95% CI 0.93 to 1.12). Endovascular aneurysm repair showed no difference in overall survival compared to open surgical repair in patients with intact abdominal aortic aneurysm (HR 1.02, 95% CI 0.93 to 1.12).