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 Wiley, Javed Suleman, Jeffrey Olin, Michael Marin, Peter Faries

Research output: Contribution to journalArticle

77 Scopus citations

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

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Dangas, G., O'Connor, D., Firwana, B., Brar, S., Ellozy, S., Vouyouka, A., Arnold, M., Kosmas, C. E., Krishnan, P., Wiley, J., 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, 5(10), 1071-1080. https://doi.org/10.1016/j.jcin.2012.06.015