Endovascular vs open repair of acute abdominal aortic aneurysms-A systematic review and meta-analysis

Objective: To compare the results of emergency open repair of acute (ruptured or symptomatic intact) abdominal aortic aneurysms with that of endovascular repair. Methods: A systematic literature search was performed to identify series that reported comparative outcomes. PubMed, Embase, the randomized controlled trial (RCT) register, and all relevant major journals were searched independently by two researchers. The outcome measures were 30-day mortality, intensive care unit (ICU) stay, hospital stay, blood loss, and operative time. Results: Twenty-three studies were identified. Of these, only one was a randomized controlled trial, which is now halted. The total number of patients in the pooled data was 7040 (730 emergency endovascular aneurysm repair [eEVAR]). Emergency EVAR was associated with a significant reduction in mortality (pooled odds ratio 0.624; 95% confidence interval [CI] 0.518 to 0.752; P < .0001). The eEVAR group's ICU stay was reduced by 4 days (pooled effect size estimate -0.70; 95% CI -1.05 to -0.35; P < .0001) and hospital stay with eEVAR was reduced by 8.6 days (pooled effect size estimate -0.33; 95% CI -0.50 to -0.16; P = .0001). In addition, eEVAR was also associated with a significant reduction in blood loss (pooled effect size estimate -1.88 liters; 95% CI -2.49 to -1.27; P < .0001) and reduced procedure time (pooled effect size estimate -0.65; 95% CI -0.95 to -0.36; P < .0001). Conclusion: This meta-analysis suggests benefits to the selected group of patients undergoing this minimally invasive procedure. There is a reduction in the high mortality, prolonged intensive care requirement and total hospital stay, which are historically associated with open repair. It also indicates that most patients are fit enough to undergo computerized tomography (CT) scanning in acute settings. However, because of heterogeneity and bias in the outcomes these results should be interpreted with caution.