Does diabetes mellitus worsen short- and long-term mortality and reintervention rates in adult patients undergoing EVAR or open abdominal aortic aneurysm repair?
Diabetes does not worsen overall long-term mortality after AAA repair, supporting the use of both EVAR and open surgical repair in diabetic patients despite a slightly higher 30-day mortality risk specifically with EVAR.
BACKGROUND: Diabetes mellitus is common among patients undergoing surgical repair of abdominal aortic aneurysms (AAAs) and is generally associated with adverse surgical outcomes. However, its influence on perioperative and long-term outcomes following AAA repair-whether endovascular (endovascular aneurysm repair EVAR) or open surgical repair (OSR)-remains uncertain. This systematic review and meta-analysis aimed to evaluate the association between diabetes and outcomes after AAA repair. METHODS: A systematic search of MEDLINE, Embase, and the Cochrane Library was performed from inception through August 2025. Comparative studies including adult patients with and without diabetes undergoing AAA repair (EVAR or OSR) were included. Primary outcomes were 30-day and long-term (≥5 years) mortality. Secondary outcomes included reintervention at 1 year and ≥5 years. Random-effects meta-analyses were conducted, with subgroup and leave-one-out sensitivity analyses. Study quality was assessed using the Newcastle-Ottawa Scale. RESULTS: Fourteen observational cohort studies including 149,206 patients (30,328 diabetics) were analyzed. Diabetes was not associated with overall 30-day or 5-year mortality. However, diabetics undergoing EVAR had higher 30-day mortality, with no difference observed after OSR. At 5 years, mortality did not differ between diabetics and nondiabetics in EVAR or OSR cohorts. Following EVAR, diabetes was associated with a lower need for reintervention at 5 years but not at 1 year, whereas endoleak rates were similar. CONCLUSION: Diabetes was not associated with worse overall short- or long-term outcomes following AAA repair. Early mortality was higher among diabetic patients undergoing EVAR, whereas long-term outcomes were comparable between EVAR and OSR. These findings support the use of both EVAR and OSR in diabetic patients, with careful perioperative optimization and postoperative surveillance.
Nawaz et al. (Sun,) studied this question.
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