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Heart and Vessels

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03.09.2015 | Original Article

Open surgery (OS) versus endovascular aneurysm repair (EVAR) for hemodynamically stable and unstable ruptured abdominal aortic aneurysm (rAAA)

verfasst von: Simeng Zhang, Jiaxuan Feng, Haiyan Li, Yongxue Zhang, Qingsheng Lu, Zaiping Jing

Erschienen in: Heart and Vessels | Ausgabe 8/2016

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Abstract

Endovascular aneurysm repair (EVAR) is an alternative treatment for ruptured abdominal aortic aneurysms (rAAA) in hemodynamically (hd) stable patients. Treatment for patients with hd-unstable rAAA remains controversial. The aim of this study was to compare the outcomes of EVAR and open surgery (OS) in hd-stable and hd-unstable rAAA patients using meta-analysis. The first part of this study included 48 articles that reported the treatment outcomes of rAAA managed with EVAR (n = 9610) and OS (n = 93867). The second part, which is the focus of this study, included 5 out of 48 articles, which further reported treatment results in hd-stable (n = 198) and hd-unstable (n = 185) patients. When heterogeneity among the groups was observed, a random-effects model was used to calculate the adjusted odds ratios (OR) or in cases of non-heterogeneity, a fixed-effects model analysis was employed. In the first part of this study, the in-hospital mortality rate was found to be lower in the EVAR group than in the OS group (29.9 vs 40.8 %; OR 0.59; 95 % CI 0.52–0.66; P < 0.01). In the second part of this study, 383 patients from 5 articles were included: 152 patients were treated by EVAR, and 231 were treated by OS. The total mortality was 147/383 (38.4 %), while the mortality of the EVAR group and the OS group was 25.7 % (39/152) and 46.8 % (108/231), respectively. In the hd-stable group, the in-hospital mortality after EVAR was significantly lower than that after OS [18.9 % (18/95) vs 28.2 % (29/103); OR 0.47; 95 % CI 0.22–0.97; P = 0.04]. For the hd-unstable rAAA patients, the in-hospital mortality after EVAR was significantly lower than that after OS [36.8 % (21/57) vs 61.7 % (79/128); OR 0.40; 95 % CI 0.20–0.79; P < 0.01]. This study indicated that compared with OS, EVAR in hd-unstable rAAA patients is associated with improved outcomes. Available publications are currently limited; thus, the best treatment strategy for this subgroup of patients remains unclear. Further clinical studies are needed to provide more detailed data, such as the shock index and long-term results.

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Titel: Open surgery (OS) versus endovascular aneurysm repair (EVAR) for hemodynamically stable and unstable ruptured abdominal aortic aneurysm (rAAA)
verfasst von: Simeng Zhang
Jiaxuan Feng
Haiyan Li
Yongxue Zhang
Qingsheng Lu
Zaiping Jing
Publikationsdatum: 03.09.2015
Verlag: Springer Japan
Erschienen in: Heart and Vessels / Ausgabe 8/2016
Print ISSN: 0910-8327
Elektronische ISSN: 1615-2573
DOI: https://doi.org/10.1007/s00380-015-0736-3

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