Objective: To compare the efficacy between endovascular aneurysm repair versus open surgery in patients with abdominal aortic aneurysms (AAA).
Methods: A systematic review was performed to identify clinical outcomes of randomized controlled trials for AAA patients receiving endovascular aneurysm repair or open surgery. The Cochrane Library (issue 7 of 2011), MEDLINE (1996 to 2011), EMBASE (1974 to 2011), CBM (1989 to 2011), CNKI (1997 to 2011), Wanfang data (1989 to 2011) were searched. Randomized trials that compared open or endovascular AAA repair and published clinical outcomes were selected. The outcome included all-cause mortality, aneurysm-related mortality, technical complications and re-open surgery. Data analyses were performed with the RevMan5.1 software. Publication bias was assessed by STATA software. A meta-regression model was used to describe between study variability. A total of 123 trials were excluded according to criteria. Four randomized controlled trials with 2607 patients met the inclusion criteria.
Results: There were no publication bias (Begg's test, Z = 1.02, P > 0.05; Egger's test, t = 0.98, P > 0.05). The meta-analysis showed that the incidence of all-cause mortality of endovascular repair was significantly lower than that of open repair up to 30 days post procedures [ RR = 0.32, 95%CI (0.18 - 0.56), P < 0.01] while long-term all-cause mortality was similar: DREAM study: [RR = 1.18, 95%CI (0.88 - 1.58), P > 0.05], EVAR study: [RR = 1.04, 95%CI (0.88 - 1.22), P > 0.05]. The incidence of aneurysm-related mortality of endovascular repair was lower than that of open repair in two studies [RR = 0.53, 95%CI (0.33 - 0.85), P < 0.01]. Technical complication between open repair group and endovascular repair group was similar [RR = 1.43, 95%CI (0.68 - 2.98), P > 0.05]. Incidence of re-open surgery was higher in endovascular repair group than in open surgery group [RR = 2.03, 95%CI (1.14 - 3.62), P < 0.05].
Conclusion: Compared with open surgery, endovascular repair is associated with lower 30-day all-cause mortality and aneurysm-related mortality, similar technical complication and long-term all-cause mortality, but higher risk for re-open surgery.
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