Hisato Takagi1, Tomo Ando2, Takuya Umemoto3. 1. Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan. Electronic address: kfgth973@ybb.ne.jp. 2. Department of Cardiology, Detroit Medical Center, Detroit, MI, United States. 3. Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan.
Abstract
OBJECTIVES: To determine whether follow-up survival is better after elective endovascular aneurysm repair (EVAR) than open surgical repair (OSR) for intact abdominal aortic aneurysm (AAA), we combined 5-year survival curves themselves of EVAR and OSR in randomized controlled trials (RCTs) and propensity-score matched (PSM) studies. METHODS: Eligible studies were RCTs or PSM studies of elective EVAR versus OSR enrolling patients with intact AAA and reporting 5-year (at least) survival curves. Data regarding detailed inclusion criteria, duration of follow-up, and survival curves were abstracted from each individual study. In case of crossing of the combined survival curves, a pooled late-phase (between the crossing time and 5years) hazard ratio (HR) for all-cause mortality was calculated. RESULTS: Our search identified 7 eligible studies (including 2 RCTs and 5 PSM studies) enrolling a total of 92,333 patients with AAA assigned to EVAR or OSR. Pooled survival rates after EVAR and OSR were 98.1% and 96.1 at 1month, 94.2% and 93.1% at 1year, 85.1% and 86.8% at 3years, and 75.8% and 78.8% at 5years, respectively. The survival curves crossed at 1.8years with the survival rate of 90.5%. A pooled late-phase (between 1.8years and 5years) HR for calculated from data of the combined survival curves significantly favored OSR (1.29, 95% confidence interval, 1.24 to 1.35; p<0.00001). CONCLUSIONS: For intact AAA, although survival was better immediately after elective EVAR than OSR, the survival curves crossed at 1.8years. Thereafter until 5years, survival was worse after EVAR than OSR.
OBJECTIVES: To determine whether follow-up survival is better after elective endovascular aneurysm repair (EVAR) than open surgical repair (OSR) for intact abdominal aortic aneurysm (AAA), we combined 5-year survival curves themselves of EVAR and OSR in randomized controlled trials (RCTs) and propensity-score matched (PSM) studies. METHODS: Eligible studies were RCTs or PSM studies of elective EVAR versus OSR enrolling patients with intact AAA and reporting 5-year (at least) survival curves. Data regarding detailed inclusion criteria, duration of follow-up, and survival curves were abstracted from each individual study. In case of crossing of the combined survival curves, a pooled late-phase (between the crossing time and 5years) hazard ratio (HR) for all-cause mortality was calculated. RESULTS: Our search identified 7 eligible studies (including 2 RCTs and 5 PSM studies) enrolling a total of 92,333 patients with AAA assigned to EVAR or OSR. Pooled survival rates after EVAR and OSR were 98.1% and 96.1 at 1month, 94.2% and 93.1% at 1year, 85.1% and 86.8% at 3years, and 75.8% and 78.8% at 5years, respectively. The survival curves crossed at 1.8years with the survival rate of 90.5%. A pooled late-phase (between 1.8years and 5years) HR for calculated from data of the combined survival curves significantly favored OSR (1.29, 95% confidence interval, 1.24 to 1.35; p<0.00001). CONCLUSIONS: For intact AAA, although survival was better immediately after elective EVAR than OSR, the survival curves crossed at 1.8years. Thereafter until 5years, survival was worse after EVAR than OSR.
Authors: Patrick Chow Yuen Ng; Brit J Long; William Tyler Davis; Daniel J Sessions; Alex Koyfman Journal: Intern Emerg Med Date: 2018-02-09 Impact factor: 3.397