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Endovascular repair or open repair for ruptured abdominal aortic aneurysm: a Cochrane systematic review
  1. S A Badger1,
  2. D W Harkin2,
  3. P H Blair2,
  4. P K Ellis2,
  5. F Kee3,
  6. R Forster4
  1. 1Mater Misericordiae University Hospital, Dublin, Ireland
  2. 2Belfast Vascular Centre, Royal Victoria Hospital, Belfast, UK
  3. 3Centre for Public Health, Queens University Belfast, Belfast, UK
  4. 4Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
  1. Correspondence to DW Harkin; denis.harkin{at}belfasttrust.hscni.net

Abstract

Objectives Emergency endovascular aneurysm repair (eEVAR) may improve outcomes for patients with ruptured abdominal aortic aneurysm (RAAA). The study aim was to compare the outcomes for eEVAR with conventional open surgical repair for the treatment of RAAA.

Setting A systematic review of relevant publications was performed. Randomised controlled trials (RCTs) comparing eEVAR with open surgical repair for RAAA were included.

Participants 3 RCTs were included, with a total of 761 patients with RAAA.

Interventions Meta-analysis was performed with fixed-effects models with ORs and 95% CIs for dichotomous data and mean differences with 95% CIs for continuous data.

Primary and secondary outcome measures Primary outcome was short-term mortality. Secondary outcome measures included aneurysm-specific and general complication rates, quality of life and economic analysis.

Results Overall risk of bias was low. There was no difference between the 2 interventions on 30-day (or in-hospital) mortality, OR 0.91 (95% CI 0.67 to 1.22; p=0.52). 30-day complications included myocardial infarction, stroke, composite cardiac complications, renal complications, severe bowel ischaemia, spinal cord ischaemia, reoperation, amputation and respiratory failure. Reporting was incomplete, and no robust conclusion was drawn. For complication outcomes that did include at least 2 studies in the meta-analysis, there was no clear evidence to support a difference between eEVAR and open repair. Longer term outcomes and cost per patient were evaluated in only a single study, thus precluding definite conclusions.

Conclusions Outcomes between eEVAR and open repair, specifically 30-day mortality, are similar. However, further high-quality trials are required, as the paucity of data currently limits the conclusions.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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