A comparison of endovascular versus open repair for ruptured abdominal aortic aneurysm – Meta-analysis of propensity score-matched data

Abstract

Background Optimal management of ruptured abdominal aortic aneurysms (rAAA) has been heavily debated in the literature. The aim of this review is to assess comparative outcomes from propensity-matched studies of endovascular versus open for rAAA. Methods Electronic databases (MEDLINE and Embase) were searched in January 2021 using the Healthcare Databases Advanced Search interface. Eligible studies compared endovascular versus open repair for rAAA using propensity-matched cohorts. Pooled estimates of perioperative outcomes were calculated using odds ratio (OR) or mean difference (MD) and 95% confidence interval (CI) using the random-effects model. Time-to-event data meta-analysis was conducted using the inverse-variance method and reported as summary hazard ratio (HR) and associated 95% CI. The quality of evidence was graded using a system developed by the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) working group. Results Six studies published between 2010 and 2020 were selected for qualitative and quantitative synthesis, reporting a total of 6731 patients. The odds of perioperative mortality after endovascular aneurysm repair (EVAR) were significantly lower than after open surgical repair (OSR) (OR 0.52, 95% CI 0.41–0.65). The hazard of overall mortality during follow-up was lower, although not significantly, after EVAR than after OSR (HR 0.79, 95% CI 0.62–1.01). The odds of acute kidney injury and early aneurysm-related reintervention were both significantly lower after EVAR than after OSR (OR 0.34, 95% CI 0.14–0.78 and OR 0.57, 95% CI 0.33–0.98, respectively). Patients treated with EVAR stayed in hospital for significantly less time than those treated with OSR (MD −5.13, 95% CI −7.94 to −2.32). The certainty of the body of evidence for perioperative mortality was low and for overall mortality was very low. Conclusion The evidence suggests that EVAR confers a significant benefit on perioperative mortality.