Key result
FEVAR is linked to ~53% higher medium-term mortality versus open surgery for juxta/pararenal AAAs.
Why the study?
The study aimed to compare the medium-term results of open surgery, fenestrated endovascular repair, and chimney endovascular repair in patients with juxta/pararenal abdominal aortic aneurysms.
Does FEVAR or ChEVAR improve medium-term outcomes compared to open surgery in patients with juxta/pararenal abdominal aortic aneurysms?
Meta-Analysis (n=4,369)
Does FEVAR or ChEVAR improve medium-term outcomes compared to open surgery in patients with juxta/pararenal abdominal aortic aneurysms?
Odds Ratio: 1.53 (95% CI 1.03–2.11)
Absolute Event Rate: 12.3% vs 8.1%
Open surgery is associated with lower medium-term all-cause mortality and fewer aortic-related reinterventions compared to FEVAR and ChEVAR in patients with juxta/pararenal abdominal aortic aneurysms, suggesting it may be preferable for younger, low-surgical-risk patients.
May favor open repair in low-risk patients; challenges endovascular preference and warrants confirmatory RCTs.
Introduction: This systematic review with network meta-analysis aimed at comparing the medium-term results of open surgery (OS), fenestrated endovascular repair (FEVAR), and chimney endovascular repair (ChEVAR) in patients with juxta/pararenal abdominal aortic aneurysms (JAAAs/PAAAs). Materials and methods: MEDLINE, SCOPUS, and Web of Science were searched from inception date to 1st July 2022. Any studies comparing the results of two or three treatment strategies (ChEVAR, FEVAR, or OS) on medium-term outcomes in patients with JAAAs/PAAAs were included. Primary outcomes were all-cause mortality, aortic-related reintervention, and aortic-related mortality, while secondary outcomes were visceral stent/bypass occlusion/occlusion, major adverse cardiovascular events (MACEs), new onset renal replacement therapy (RRT), total endoleaks, and type I/III endoleak. Results: FEVAR (OR = 1.53, 95%CrI 1.03–2.11) was associated with higher medium-term all-cause mortality than OS. Sensitivity analysis including only studies that analysed JAAA showed that FEVAR (OR = 1.65, 95%CrI 1.08–2.33) persisted to be associated with higher medium-term mortality than OS. Both FEVAR (OR = 8.32, 95%CrI 3.80–27.16) and ChEVAR (OR = 5.95, 95%CrI 2.23–20.18) were associated with a higher aortic-related reintervention rate than OS. No difference between different treatment options was found in terms of aortic-related mortality. FEVAR (OR = 13.13, 95%CrI 2.70–105.2) and ChEVAR (OR = 16.82, 95%CrI 2.79–176.7) were associated with a higher rate of medium-term visceral branch occlusion/stenosis compared to OS; however, there was no difference found between FEVAR and ChEVAR. Conclusions: An advantage of OS compared to FEVAR and ChEVAR after mid-term follow-up aortic-related intervention and vessel branch/bypass stenosis/occlusion was found. This suggests that younger, low-surgical-risk patients might benefit from open surgery of JAAA/PAAA as a first approach.
No takes yet. Share an insight, caveat, or question.
Zlatanović et al. (2022) conducted a meta-analysis in Juxta/pararenal abdominal aortic aneurysms (n=4,369). Fenestrated endovascular repair (FEVAR) vs. Open surgery (OS) was evaluated on Medium-term all-cause mortality (OR 1.53, 95% CI 1.03-2.11). Fenestrated endovascular repair was associated with higher medium-term all-cause mortality compared to open surgery (OR 1.53) in patients with juxta/pararenal abdominal aortic aneurysms.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: