Endovascular versus Open Surgery Repair of Ruptured Abdominal Aortic Aneurysms in Hemodynamically Unstable Patients: Literature Review and Meta-Analysis

Annals of Vascular Surgery
Yonghui LiChen Yao

Abstract

The better outcome achieved by endovascular aortic repair (EVAR) in ruptured abdominal aortic aneurysm (rAAA) patients might derive from the fact that patients with hemodynamic instability preferentially underwent open repair. To further evaluate the effect of EVAR for rAAAs, a meta-analysis of studies in which hemodynamic instability was similar between the 2 treatment groups was conducted. MEDLINE, EMBASE, ISI Web of Knowledge, and the Cochrane Library were searched from January 2004 to May 2014 for randomized controlled trials (RCTs) and observational studies that compared EVAR with open surgery repair in rAAA patients. Three RCTs and 10 observational studies covering 1,784 patients were included. Perioperative mortality occurred in 27.3% of the patients treated with EVAR and in 38.1% of the patients who underwent open repair. Subgroup analysis revealed consistent results in favor of EVAR in single-center, observational studies. Subgroup analysis and meta-regression analysis indicated that the superior effect of EVAR might be associated with more anatomically suitable patients in EVAR group. The findings from our meta-analysis support EVAR in properly selective rAAA patients.

References

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Citations

Aug 23, 2017·Vascular·Hilin YildirimJean-Paul Pm de Vries
Jan 2, 2019·Journal of Vascular Surgery·Vincent J NooriUNKNOWN Vascular Study Group of New England

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