Benefit Of Using Endovascular Aneurysm Repair Versus Open Surgery For Abdominal Aortic Aneurysms: A Meta-analysis

Objective: To determine the benefit of endovascular aneurysm repair versus opensurgery for abdominal aortic aneurysms (AAA). Methods: A systematic review for therandomized controlled trial was performed to identify clinical outcomes betweenendovascular aneurysm repair and open surgery for abdominal aortic aneurysms. TheCochrane Library (Issue7.2011), MEDLINE (1996to August2011), EMBASE (1974toAugust2011), CBM (1989to2011), CNKI (1997to August2011), VIP (1989to2011)were searched. Randomized trials that compared open or endovascular AAA repair andpublished clinical outcomes were selected. The outcome measures were all-cause mortality,aneurysm-related mortality, technical complications and re-open repair. The quality ofincluded studies was critically evaluated. Data analyses were performed with TheRevMan5.1software. Publication bias was assessed using Egger’s test by STATA software.A meta-regression model was uesd to explain between study variability. Seven trials wereexcluded according to criteria. Four randomized controlled trials with2607patients metthe inclusion criteria. Publication bias z=1.02, P=0.31, Begg ’s test; t=0.98, P=0.43, Egger’s test. No publication bias has been found. Results: The meta-analysis show that theincidence of all-cause mortality of endovascular repair was significantly lower than openrepair in the early result [RR=0.32,95%CI(0.18,0.56), P＜0.01]. Endovascular repair hasnot been shown to decrease long-term all-cause mortality compared with open repair bythe result of two trials. DREAM study:[RR=1.18,95%CI(0.88,1.58), P=0.27], EVARstudy:[RR=1.04,95%CI(0.88,1.22), P=0.64]. The incidence of aneurysm-relatedmortality of endovascular repair was lower than open repair in two study,[RR=0.53,95%CI (0.33,0.85), P＜0.01]. Four trials compared the technical complication between open repair group and endovascular repair group. Endovascular repair did not increasetechnical complication,[RR=1.43,95%CI (0.68,2.98), P=0.35]. Open repair group haslower rate of re-open repair than endovascular repair group in two trial，[RR=2.03,95%CI(1.14,3.62), P=0.02]. Two non-randomized controlled trials showed all-cause mortalityof Endovascular therapy were significantly lower than open repair [OR=0.3,95%CI(0.15,0.59), P＜0.05]; the incidence of surgrey-related Complications of Endovascular therapywere no significantly increased [OR=0.33,95%CI (0.07,1.50), P=0.18]; Conclusion:Endovascular repair is associated with lower30-day all-cause mortality andaneurysm-related mortality than open repair, similar technical complication, but has notbeen shown to decrease long-term mortality.