A meta-analysis of adjusted observational studies and randomized controlled trials of endovascular versus open surgical repair for ruptured abdominal aortic aneurysm.

INTRODUCTION: The aim of the present meta-analysis was to determine whether endovascular aneurysm repair (EVAR) reduces perioperative mortality and improves overall survival compared with open surgical repair (OSR) in patients with ruptured abdominal aortic aneurysm (RAAA). EVIDENCE ACQUISITION: Eligible studies were observational studies with adjusted risk estimates or randomized controlled trials (RCTs) of EVAR versus OSR enrolling individuals with RAAA and reporting perioperative (30-day or in-hospital) or overall (≥3-month) all-cause mortality. EVIDENCE SYNTHESIS: Twenty-four adjusted observational studies and 4 RCTs enrolling a total of 56,826 patients with RAAA were identified and included. For perioperative all-cause mortality, pooled analyses of 22 adjusted observational studies and 4 RCTs respectively demonstrated a statistically significant 49% reduction with EVAR relative to OSR (odds ratio [OR]=0.51; 95% confidence interval [CI]: 0.44 to 0.59; P<0.00001) and no statistically significant difference between EVAR and OSR (OR=0.91; 95% CI: 0.68 to 1.22; P=0.53) (P for subgroup differences = 0.0006). For overall (3 months to 8 years) all-cause mortality, a pooled analysis of 7 adjusted observational studies (hazard ratio [HR]=0.92; 95% CI: 0.77 to 1.10; P=0.37) and 3 RCTs (HR=0.89; 95% CI: 0.69 to 1.14; P=0.34) demonstrated no statistically significant difference between EVAR and OSR (P for subgroup differences = 0.81).
CONCLUSIONS: In patients with RAAA, EVAR is likely effective in prevention of perioperative overall (3 months to 8 years), not all-cause mortality.