A meta-analysis of 21178 patients undergoing open or endovascular repair of abdominal aortic aneurysm

Background: Several studies have compared outcomes after elective open and endovascular approaches to abdominal aortic aneurysm (AAA) surgery, with varying results. Methods: A random-effects meta-analysis was undertaken to compare operative outcomes, postoperative complications, 30-day mortality and long-term patient survival after surgery. Endpoints were compared using odds ratios (ORs), weighted mean differences (WMDs) or log hazard ratios (HRs) as appropriate. Results: Forty-two studies comprising 21178 patients (10 855 open; 10 323 endovascular) were included. In the elective setting (20715 patients), the endovascular method was associated with a shorter stay in intensive care (WMD -36 h; P < 0.001) and a shorter total postoperative stay (WMD -5-4 days; P < 0.001). Cardiac (OR 1.76; P = 0.002) and respiratory (OR 4.01; P < 0.001) complications were more common after open surgery. In the endovascular group, 30-day mortality was lower (OR 0.46; P < 0.001). Endovascular surgery was also associated with an improved long-term aneurysm-related mortality (HR 0.39; P < 0.001). For ruptured AAA (463 patients), the less invasive operation was associated with a reduced stay in intensive care (WMD -100.4 h; P = 0.005) and a significantly lower 30-day mortality (OR 0.45; P = 0.005). Conclusions: The endovascular repair of AAA offers a clear benefit in terms of reduction in postoperative adverse events and 30-day mortality. In the longer term, it is also associated with a reduction in aneurysm-related mortality, but not in all-cause mortality.