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. 2016 Feb 12;6(2):e008391.
doi: 10.1136/bmjopen-2015-008391.

Endovascular repair or open repair for ruptured abdominal aortic aneurysm: a Cochrane systematic review

S A Badger  1 , D W Harkin  2 , P H Blair  2 , P K Ellis  2 , F Kee  3 , R Forster  4
Affiliations

Endovascular repair or open repair for ruptured abdominal aortic aneurysm: a Cochrane systematic review

S A Badger et al. BMJ Open. .

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.

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Figures

Figure 1
Figure 1
PRISMA flow chart of literature selection. TSC, Trials Search Co-ordinator.
Figure 2
Figure 2
Short-term mortality (30-day or in-hospital) of emergency endovascular aneurysm repair (eEVAR) versus open repair.
Figure 3
Figure 3
Myocardial infarction of emergency endovascular aneurysm repair (eEVAR) versus open repair.
Figure 4
Figure 4
Stroke complication of emergency endovascular aneurysm repair (eEVAR) versus open repair.
Figure 5
Figure 5
Cardiac complication (moderate or severe) of emergency endovascular aneurysm repair (eEVAR) versus open repair.
Figure 6
Figure 6
Renal complications (moderate or severe) of emergency endovascular aneurysm repair (eEVAR) versus open repair.
Figure 7
Figure 7
Bowel ischaemia of emergency endovascular aneurysm repair (eEVAR) versus open repair.
Figure 8
Figure 8
Spinal cord ischaemia of emergency endovascular aneurysm repair (eEVAR) versus open repair.
Figure 9
Figure 9
Reoperation of emergency endovascular aneurysm repair (eEVAR) versus open repair.
Figure 10
Figure 10
Amputation after emergency endovascular aneurysm repair (eEVAR) versus open repair.
Figure 11
Figure 11
Respiratory failure of emergency endovascular aneurysm repair (eEVAR) versus open repair.
Figure 12
Figure 12
Mortality at 6 month for emergency endovascular aneurysm repair (eEVAR) versus open repair.
Figure 13
Figure 13
Reoperation at 6 months for emergency endovascular aneurysm repair (eEVAR) versus open repair.
Figure 14
Figure 14
Cost per patient (30 days) of emergency endovascular aneurysm repair (eEVAR) versus open repair.
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