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February 8, 2015Cochrane libraryOpen Access

Pooled analysis of two trials comparing early open repair with surveillance showed no evidence of a difference in survival (propensity score-adjusted HR 0.99, 95% CI 0.83 to 1.18).

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Why the study?

Does early surgical repair improve survival compared to routine ultrasound surveillance in people with small asymptomatic abdominal aortic aneurysms (4.0 to 5.5 cm)?

Population

3314 participants with asymptomatic abdominal aortic aneurysms between 4.0 cm and 5.5 cm in diameter from 4…

Comparison

Early surgical repair vs Routine ultrasound surveillance

Design

Systematic_review

Follow-up

up to 12 years

Authors

GFGiovanni FilardoJPJanet T. PowellMMMelissa Martínez

Discussion

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Overview

Surveillance remains standard for small asymptomatic AAAs; confirms no survival benefit from early open repair in pooled trials.

Key Points

  • To evaluate mortality, healthcare costs, quality of life, and rupture rates associated with early surgical repair versus regular ultrasound surveillance in patients with asymptomatic abdominal aortic aneurysms measuring 4.0 cm to 5.5 cm.
  • Systematic review of 4 randomized controlled trials (N = 3,314) comparing early surgical intervention (open repair or endovascular repair) with regular ultrasound surveillance at least every 6 months.
  • Primary outcomes included long-term and short-term survival; certainty of evidence was graded using GRADE methodology.
  • Surveillance showed an early survival advantage due to 30-day operative mortality with repair, but pooled participant-level analysis of early open repair versus surveillance showed no difference in long-term survival (propensity score-adjusted HR 0.99, 95% CI 0.83 to 1.18; N = 2,226; high-certainty evidence).
  • Early endovascular repair did not improve 12-month survival compared with surveillance (RR 1.92, 95% CI 0.73 to 5.06; N = 846; low-certainty evidence).
  • Short-term costs were significantly higher for early repair, including UK open repair at 18 months (MD GBP 1,064, 95% CI 796 to 1,332) and US endovascular repair at 6 months (MD USD 27,951, 95% CI 25,156 to 30,746), though total 4-year costs for endovascular repair showed no clear difference (MD USD 2,557, 95% CI -8,043 to 13,156).

Structured PICO

Does early surgical repair improve survival compared to routine ultrasound surveillance in people with small asymptomatic abdominal aortic aneurysms (4.0 to 5.5 cm)?

P
Population
3314 participants with asymptomatic abdominal aortic aneurysms (AAAs) between 4.0 cm and 5.5 cm in diameter from 4 RCTs.
I
Intervention
Early surgical repair (open repair or endovascular repair [EVAR])
C
Comparator
Routine ultrasound surveillance (imaging-based surveillance at least every six months)
O
Outcome
Mortality and costshard clinical

Early surgical repair of small asymptomatic abdominal aortic aneurysms (4.0-5.5 cm) does not improve long-term survival compared to routine ultrasound surveillance.

Limitations

  • Long-term data from EVAR trials are not available
  • Lack of data regarding ethnic minorities and women
  • Some outcomes only reported by one study

Cite This Study

Filardo et al. (2015) studied this question.

synapsesocial.com/papers/6a70de088031ec7bb1dca329https://doi.org/10.1002/14651858.cd001835.pub4
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Also Consider

Synapse has enriched 4 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Meta-analysis of individual-patient data from EVAR-1, DREAM, OVER and ACE trials comparing outcomes of endovascular or open repair for abdominal aortic aneurysm over 5 years2017 · 432 citations
  2. 2Impact of the first 5 years of a national abdominal aortic aneurysm screening programme2016 · 153 citations
  3. 3Global and Regional Burden of Aortic Dissection and Aneurysms: Mortality Trends in 21 World Regions, 1990 to 20102014 · 306 citations
  4. 4Meta-analysis of individual patient data to examine factors affecting growth and rupture of small abdominal aortic aneurysms2012 · 550 citations