Open versus endovascular stent graft repair of abdominal aortic aneurysms: A meta-analysis of randomized trials

George Dangas, David O'Connor, Belal Firwana, Somjot Brar, Sharif Ellozy, Angeliki Vouyouka, Margaret Arnold, Constantine E. Kosmas, Prakash Krishnan, Jose M. Wiley, Javed Suleman, Jeffrey Olin, Michael Marin, Peter Faries

Research output: Contribution to journalArticle

74 Citations (Scopus)

Abstract

Objectives: This study sought to evaluate the short-, intermediate-, and longer-term outcomes after endovascular versus open repair of abdominal aortic aneurysms (AAA), including both AAA-related and all-cause mortality. Background: Endovascular stent graft placement for AAA has gained broad acceptance as an alternative to open surgical repair due to a lower perioperative morbidity and mortality. The intermediate- and long-term all-cause and aneurysm-related mortality vary among studies. Thus, we sought to perform a meta-analysis of open versus endovascular repair for treating AAA. Methods: Electronic databases were queried for identification of prospective, randomized trials of open surgery versus endovascular stent graft repair of AAA. A total of 10 published papers reporting on 6 studies at different follow-up intervals were identified; they involved 2,899 patients with AAA repair procedures, of whom, 1,470 underwent endovascular stent graft AAA exclusion and 1,429 were treated by open AAA repair. Results: At 30 days, the pooled relative risk of all-cause mortality was lower in the endovascular group (relative risk [RR]: 0.35, 95% confidence interval [CI]: 0.19 to 0.64) than in the open surgery group. At intermediate follow-up, the all-cause mortality had a nonsignificant difference (RR: 0.78, 95% CI: 0.57 to 1.08), the AAA-related mortality was significantly lower (RR: 0.46, 95% CI: 0.28 to 0.74) and reintervention rates were higher (RR: 1.48, 95% CI: 1.06 to 2.08) in the endovascular group than in the open surgery group. At long-term follow-up, there was no significant difference in all-cause mortality (RR: 0.99, 95% CI: 0.85 to 1.15) or AAA-related mortality (RR: 1.58, 95% CI: 0.20 to 12.74), whereas the significant difference in the rate of reinterventions persisted (RR: 2.54, 95% CI: 1.58 to 4.08). Conclusions: In patients randomized to open or endovascular AAA repair, all-cause perioperative mortality, as well as AAA-related mortality at short- and intermediate-term follow-up are lower in patients undergoing endovascular stent graft placement. This was associated with greater reintervention in the endovascular group noted at intermediate follow-up. Long-term survival appears to converge between the 2 groups.

Original languageEnglish (US)
Pages (from-to)1071-1080
Number of pages10
JournalJACC: Cardiovascular Interventions
Volume5
Issue number10
DOIs
StatePublished - Oct 2012
Externally publishedYes

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Abdominal Aortic Aneurysm
Stents
Meta-Analysis
Transplants
Mortality
Confidence Intervals
Aneurysm
Databases
Morbidity

Keywords

  • abdominal aortic aneurysm
  • aortic aneurysm
  • endovascular procedure
  • general surgery
  • vascular disease
  • vascular surgical procedures

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Open versus endovascular stent graft repair of abdominal aortic aneurysms : A meta-analysis of randomized trials. / Dangas, George; O'Connor, David; Firwana, Belal; Brar, Somjot; Ellozy, Sharif; Vouyouka, Angeliki; Arnold, Margaret; Kosmas, Constantine E.; Krishnan, Prakash; Wiley, Jose M.; Suleman, Javed; Olin, Jeffrey; Marin, Michael; Faries, Peter.

In: JACC: Cardiovascular Interventions, Vol. 5, No. 10, 10.2012, p. 1071-1080.

Research output: Contribution to journalArticle

Dangas, G, O'Connor, D, Firwana, B, Brar, S, Ellozy, S, Vouyouka, A, Arnold, M, Kosmas, CE, Krishnan, P, Wiley, JM, Suleman, J, Olin, J, Marin, M & Faries, P 2012, 'Open versus endovascular stent graft repair of abdominal aortic aneurysms: A meta-analysis of randomized trials', JACC: Cardiovascular Interventions, vol. 5, no. 10, pp. 1071-1080. https://doi.org/10.1016/j.jcin.2012.06.015
Dangas, George ; O'Connor, David ; Firwana, Belal ; Brar, Somjot ; Ellozy, Sharif ; Vouyouka, Angeliki ; Arnold, Margaret ; Kosmas, Constantine E. ; Krishnan, Prakash ; Wiley, Jose M. ; Suleman, Javed ; Olin, Jeffrey ; Marin, Michael ; Faries, Peter. / Open versus endovascular stent graft repair of abdominal aortic aneurysms : A meta-analysis of randomized trials. In: JACC: Cardiovascular Interventions. 2012 ; Vol. 5, No. 10. pp. 1071-1080.
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abstract = "Objectives: This study sought to evaluate the short-, intermediate-, and longer-term outcomes after endovascular versus open repair of abdominal aortic aneurysms (AAA), including both AAA-related and all-cause mortality. Background: Endovascular stent graft placement for AAA has gained broad acceptance as an alternative to open surgical repair due to a lower perioperative morbidity and mortality. The intermediate- and long-term all-cause and aneurysm-related mortality vary among studies. Thus, we sought to perform a meta-analysis of open versus endovascular repair for treating AAA. Methods: Electronic databases were queried for identification of prospective, randomized trials of open surgery versus endovascular stent graft repair of AAA. A total of 10 published papers reporting on 6 studies at different follow-up intervals were identified; they involved 2,899 patients with AAA repair procedures, of whom, 1,470 underwent endovascular stent graft AAA exclusion and 1,429 were treated by open AAA repair. Results: At 30 days, the pooled relative risk of all-cause mortality was lower in the endovascular group (relative risk [RR]: 0.35, 95{\%} confidence interval [CI]: 0.19 to 0.64) than in the open surgery group. At intermediate follow-up, the all-cause mortality had a nonsignificant difference (RR: 0.78, 95{\%} CI: 0.57 to 1.08), the AAA-related mortality was significantly lower (RR: 0.46, 95{\%} CI: 0.28 to 0.74) and reintervention rates were higher (RR: 1.48, 95{\%} CI: 1.06 to 2.08) in the endovascular group than in the open surgery group. At long-term follow-up, there was no significant difference in all-cause mortality (RR: 0.99, 95{\%} CI: 0.85 to 1.15) or AAA-related mortality (RR: 1.58, 95{\%} CI: 0.20 to 12.74), whereas the significant difference in the rate of reinterventions persisted (RR: 2.54, 95{\%} CI: 1.58 to 4.08). Conclusions: In patients randomized to open or endovascular AAA repair, all-cause perioperative mortality, as well as AAA-related mortality at short- and intermediate-term follow-up are lower in patients undergoing endovascular stent graft placement. This was associated with greater reintervention in the endovascular group noted at intermediate follow-up. Long-term survival appears to converge between the 2 groups.",
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author = "George Dangas and David O'Connor and Belal Firwana and Somjot Brar and Sharif Ellozy and Angeliki Vouyouka and Margaret Arnold and Kosmas, {Constantine E.} and Prakash Krishnan and Wiley, {Jose M.} and Javed Suleman and Jeffrey Olin and Michael Marin and Peter Faries",
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T1 - Open versus endovascular stent graft repair of abdominal aortic aneurysms

T2 - A meta-analysis of randomized trials

AU - Dangas, George

AU - O'Connor, David

AU - Firwana, Belal

AU - Brar, Somjot

AU - Ellozy, Sharif

AU - Vouyouka, Angeliki

AU - Arnold, Margaret

AU - Kosmas, Constantine E.

AU - Krishnan, Prakash

AU - Wiley, Jose M.

AU - Suleman, Javed

AU - Olin, Jeffrey

AU - Marin, Michael

AU - Faries, Peter

PY - 2012/10

Y1 - 2012/10

N2 - Objectives: This study sought to evaluate the short-, intermediate-, and longer-term outcomes after endovascular versus open repair of abdominal aortic aneurysms (AAA), including both AAA-related and all-cause mortality. Background: Endovascular stent graft placement for AAA has gained broad acceptance as an alternative to open surgical repair due to a lower perioperative morbidity and mortality. The intermediate- and long-term all-cause and aneurysm-related mortality vary among studies. Thus, we sought to perform a meta-analysis of open versus endovascular repair for treating AAA. Methods: Electronic databases were queried for identification of prospective, randomized trials of open surgery versus endovascular stent graft repair of AAA. A total of 10 published papers reporting on 6 studies at different follow-up intervals were identified; they involved 2,899 patients with AAA repair procedures, of whom, 1,470 underwent endovascular stent graft AAA exclusion and 1,429 were treated by open AAA repair. Results: At 30 days, the pooled relative risk of all-cause mortality was lower in the endovascular group (relative risk [RR]: 0.35, 95% confidence interval [CI]: 0.19 to 0.64) than in the open surgery group. At intermediate follow-up, the all-cause mortality had a nonsignificant difference (RR: 0.78, 95% CI: 0.57 to 1.08), the AAA-related mortality was significantly lower (RR: 0.46, 95% CI: 0.28 to 0.74) and reintervention rates were higher (RR: 1.48, 95% CI: 1.06 to 2.08) in the endovascular group than in the open surgery group. At long-term follow-up, there was no significant difference in all-cause mortality (RR: 0.99, 95% CI: 0.85 to 1.15) or AAA-related mortality (RR: 1.58, 95% CI: 0.20 to 12.74), whereas the significant difference in the rate of reinterventions persisted (RR: 2.54, 95% CI: 1.58 to 4.08). Conclusions: In patients randomized to open or endovascular AAA repair, all-cause perioperative mortality, as well as AAA-related mortality at short- and intermediate-term follow-up are lower in patients undergoing endovascular stent graft placement. This was associated with greater reintervention in the endovascular group noted at intermediate follow-up. Long-term survival appears to converge between the 2 groups.

AB - Objectives: This study sought to evaluate the short-, intermediate-, and longer-term outcomes after endovascular versus open repair of abdominal aortic aneurysms (AAA), including both AAA-related and all-cause mortality. Background: Endovascular stent graft placement for AAA has gained broad acceptance as an alternative to open surgical repair due to a lower perioperative morbidity and mortality. The intermediate- and long-term all-cause and aneurysm-related mortality vary among studies. Thus, we sought to perform a meta-analysis of open versus endovascular repair for treating AAA. Methods: Electronic databases were queried for identification of prospective, randomized trials of open surgery versus endovascular stent graft repair of AAA. A total of 10 published papers reporting on 6 studies at different follow-up intervals were identified; they involved 2,899 patients with AAA repair procedures, of whom, 1,470 underwent endovascular stent graft AAA exclusion and 1,429 were treated by open AAA repair. Results: At 30 days, the pooled relative risk of all-cause mortality was lower in the endovascular group (relative risk [RR]: 0.35, 95% confidence interval [CI]: 0.19 to 0.64) than in the open surgery group. At intermediate follow-up, the all-cause mortality had a nonsignificant difference (RR: 0.78, 95% CI: 0.57 to 1.08), the AAA-related mortality was significantly lower (RR: 0.46, 95% CI: 0.28 to 0.74) and reintervention rates were higher (RR: 1.48, 95% CI: 1.06 to 2.08) in the endovascular group than in the open surgery group. At long-term follow-up, there was no significant difference in all-cause mortality (RR: 0.99, 95% CI: 0.85 to 1.15) or AAA-related mortality (RR: 1.58, 95% CI: 0.20 to 12.74), whereas the significant difference in the rate of reinterventions persisted (RR: 2.54, 95% CI: 1.58 to 4.08). Conclusions: In patients randomized to open or endovascular AAA repair, all-cause perioperative mortality, as well as AAA-related mortality at short- and intermediate-term follow-up are lower in patients undergoing endovascular stent graft placement. This was associated with greater reintervention in the endovascular group noted at intermediate follow-up. Long-term survival appears to converge between the 2 groups.

KW - abdominal aortic aneurysm

KW - aortic aneurysm

KW - endovascular procedure

KW - general surgery

KW - vascular disease

KW - vascular surgical procedures

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