Key result
Advanced EVAR reduces postoperative complications ~47% vs open surgery but links to higher long-term mortality.
Why the study?
Open surgery remains the gold standard for complex abdominal aortic aneurysm, but the effectiveness of newly developed advanced-EVAR compared to open surgery remains unclear.
Does advanced EVAR improve mortality and complication rates compared to open surgery in patients with complex abdominal aortic aneurysm?
Meta-Analysis (n=12,845)
Does advanced EVAR improve mortality and complication rates compared to open surgery in patients with complex abdominal aortic aneurysm?
Relative Risk: 0.53 (95% CI 0.49–0.57)
p-value: p=<0.001
Advanced EVAR for complex abdominal aortic aneurysms offers short-term benefits in mortality and complications but is associated with worse long-term mortality and higher reintervention rates compared to open surgery.
Supports perioperative advantage of advanced EVAR in complex AAA; leaves open long-term survival versus open repair.
Background Open surgery is still acknowledged as the gold standard for complex abdominal aortic aneurysm (c-AAA). Recently, advanced-endovascular aortic aneurysm repair (EVAR) for c-AAA has been developed, but its effectiveness compared to open surgery is still unclear. Method A systematic search was performed on the MEDLINE through PubMed and ScienceDirect databases. The search was aimed to investigate outcomes of both fenestrated- and chimney-EVAR (consider as advanced EVAR) compared to open surgery in c-AAA. Outcomes included postoperative complications, 30-day mortality, long-term mortality, and reintervention rate. Data were collected using the Mantel–Haenszel fixed effects model with relative risk (RR) as the effect size with 95% confidence interval (CI). Results A total of 25 studies ( n = 12,845 patients) were included in our study. The results demonstrated that advanced-EVAR correlated with diminished postoperative complications (RR 0.53; 95% CI 0.49–0.57; p < 0.001) compared to open surgery. Advanced-EVAR was associated with lower 30-day mortality compared to open surgery (RR 0.66; 95% CI 0.53–0.82; p < 0.001). Subgroup analysis revealed that fenestrated-EVAR resulted in superior outcomes ( p < 0.001), whereas the chimney-EVAR subgroup did not show significant differences ( p = 0.79), compared to open surgery in terms of 30-day mortality. Unfortunately, advanced-EVAR was associated with a higher long-term mortality rate (RR 1.46; 95% CI 1.20–1.78; p < 0.001) and a higher reintervention rate (RR 1.26; 95% CI 1.01–1.59; p = 0.04) compared to open surgery. Conclusion Advanced EVAR, especially fenestrated-EVAR, presented better short-term outcomes compared to open surgery; however, it failed to demonstrate superiority over open surgery in improving long-term outcomes.
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Pertiwi et al. (2024) conducted a meta-analysis in complex abdominal aortic aneurysm (c-AAA) (n=12,845). Advanced EVAR (fenestrated- and chimney-EVAR) vs. Open surgery was evaluated on postoperative complications (RR 0.53, 95% CI 0.49-0.57, p=<0.001). Advanced EVAR reduced postoperative complications (RR 0.53; 95% CI 0.49-0.57; p<0.001) and 30-day mortality compared to open surgery, but was associated with higher long-term mortality.
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