Abstract
Objective
The purpose of this systematic review and meta-analysis was to compare the short and
long-term outcomes of endovascular repair (ER) versus open surgical repair (OSR) for
complex abdominal aortic aneurysms (CAAAs), using propensity-matched and non-propensity-matched
methods.
Methods
PubMed, OVID, Embase, ELSEVIER and Cochrane library were searched for the studies
that compared ER versus OSR for CAAAs from January 1999 to December 2020. CAAAs were
defined as short neck, juxtarenal, pararenal and suprarenal abdominal aortic aneurysms.
The primary outcomes were 30-day mortality, 30-day reintervention, medium and long-term
survival. We pooled outcomes of original studies and also performed subgroup analyses
using RevMan. The analysis of statistical heterogeneity was performed with STATA 16.0.
Results
21 studies with 12049 patients (3847 ERs, 8202 OSRs) were included in this meta-analysis.
In general, the patients undergoing ER were significantly older and likely to be man;
more common with diabetes mellitus, congestive heart failure, renal failure, but smaller
aortic aneurysms. In the non-propensity-matched subgroup analysis of ER versus OSR,
ER was associated with significantly decreased 30-day mortality (odds ratio [OR]:
0.60; 95% confidence interval [CI]: 0.49-0.74; P＜.001; I2=4%) and 30-day reintervention (OR: 0.59; 95% CI: 0.40-0.87; P = .007; I2=56%); lower rate of long-term survival (hazard ratio [HR]: 1.73; 95% CI: 1.21-2.47;
P = .002; I2=0%); less perioperative comorbidities including myocardial infarction, arrhythmia,
acute kidney injury, permanent dialysis, wound complications, bowel ischemia; and
shorter hospital length of stay. In the propensity-matched subgroup, ER was associated
with poorer long-term survival (HR: 1.80; 95% CI: 1.06-3.06; P = .03; I2=0%), higher incidences of lower extremity ischemia (OR: 12.25; 95% CI: 1.54-97.48;
P = .02; I2=16%) and renal artery restenosis (OR: 7.63; 95% CI: 1.35-43.24; P = .02). However,
there was no significant difference in 30-day mortality (OR: 1.31; 95% CI: 0.65-2.66;
P = .45; I2=0%), 30-day reintervention (OR: 1.58; 95% CI: 0.62-4.03; P = .34; I2=26%), mid-term survival (HR: 1.03; 95% CI: 0.30-3.56; P = .96; I2=0%) between ER and OSR groups.
Conclusion
Our analyses suggest that OSR of CAAAs, compared with ER, is associated with improved
long-term survival without increasing of perioperative deaths. ER may be considered
in the patients who are high-risk for open repair.
Keywords
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Article Info
Publication History
Accepted:
June 30,
2022
Received in revised form:
June 11,
2022
Received:
December 16,
2021
Publication stage
In Press Journal Pre-ProofFootnotes
Conflicts of Interest/Competing Interests: The authors declare no conflicts of interest.
Funding Source: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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© 2022 Published by Elsevier Inc.
