Abdominal Aortic Aneurysm Research Today is a free monthly online journal that collates and summarizes the latest research about Abdominal Aortic Aneurysm, including details on aaa (abdominal aortic aneurism), cardiac disease, treatment, symptoms, surgery. | ||||||||
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A meta-analysis of 21,178 patients undergoing open or endovascular repair of abdominal aortic aneurysm.Lovegrove RE, Javid M, Magee TR, Galland RB Department of General Surgery, Royal Berkshire Hospital, London Road, Reading RG1 5AN, UK. BACKGROUND: Several studies have compared outcomes after elective open and endovascular approaches to abdominal aortic aneurysm (AAA) surgery, with varying results. METHODS: A random-effects meta-analysis was undertaken to compare operative outcomes, postoperative complications, 30-day mortality and long-term patient survival after surgery. Endpoints were compared using odds ratios (ORs), weighted mean differences (WMDs) or log hazard ratios (HRs) as appropriate. RESULTS: Forty-two studies comprising 21,178 patients (10,855 open; 10,323 endovascular) were included. In the elective setting (20,715 patients), the endovascular method was associated with a shorter stay in intensive care (WMD--36 h; P < 0.001) and a shorter total postoperative stay (WMD--5.4 days; P < 0.001). Cardiac (OR 1.76; P = 0.002) and respiratory (OR 4.01; P < 0.001) complications were more common after open surgery. In the endovascular group, 30-day mortality was lower (OR 0.46; P < 0.001). Endovascular surgery was also associated with an improved long-term aneurysm-related mortality (HR 0.39; P < 0.001). For ruptured AAA (463 patients), the less invasive operation was associated with a reduced stay in intensive care (WMD--100.4 h; P = 0.005) and a significantly lower 30-day mortality (OR 0.45; P = 0.005). CONCLUSIONS: The endovascular repair of AAA offers a clear benefit in terms of reduction in postoperative adverse events and 30-day mortality. In the longer term, it is also associated with a reduction in aneurysm-related mortality, but not in all-cause mortality. Published 5 May 2008 in Br J Surg, 95(6): 677-84.
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