Effectiveness And Safety Of Endovascular Repair Versus Open Repair For Abdominal Aortic Aneurysms: A Systematic Review And Meta-analyses Of Randomized Controlled Trials

Objective:To evaluate the efficacy and safety of ER compared with OR for AAA. Method: We searched MEDLINE (OVID, 1990 to 2008), EMBASE.com (1990 to 2008), Cochrane Central Register of Controlled Trials (1991 to October 2008), PubMed ( 1990 to 2008), Chinese Biomedical Literature Database (CBM), Chinese Scientific Journal Full-text Database (CSJD), and Chinese Journal Full-text Database (CJFD), added with handsearching and other retrievals.The Cochrane Collaboration's RevMan 5.0.18 was used for meta-analyses. Results: Four RCTs including 6 literatures reporting data on safety and efficacy of ER versus OR were included. Meta-analyses showed that ER was superior to OR as measured by the 30-day all cause mortality (OR 0.32; 95%CI 0.16 to 0.62; P=0.0008) and mid-term AAA-cause mortality (OR 0.50, 95%CI 0.30 to 0.85; P=0.010) . Mid-term all-cause mortality: ER was similar with open repair (OR 0.91, 95%CI 0.69 to 1.19; P=0.48). About mid-term all-complication, no significant difference was observed between ER and OR (OR 2.51, 95%CI 0.48 to 13.04; P=0.27). OR was superior to ER as measured by the reintervation rate (OR 2.2; 95%CI 1.67 to 2.88; P<0.00001). Conclusion: The short-term efficacy of ER is better than OR on the treatment of infrarenal and unruptured aortic aneurysms. Although the mid-term all-cause mortality is similar: the risk of reintervation rate is higher than ER. Methodologically sound and adequately powered RCTs with long-term follow-up are needed.