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A comparative study on the medium-long term results of endovascular repair and open surgical repair in the management of ruptured abdominal aortic aneurysms

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Han Yanshuo 1   Zhang Jian 1 *   Xia Qian 1   Liu Zhimin 1   Zhang Xiaoyu 1   Wu Xiaoyu 1   Lun Yu 1   Xin Shijie 1   Duan Zhiquan 1   Xu Ke 2  
文摘 Background Although it is generally acknowledged that patients with ruptured abdominal aortic aneurysm (rAAA) obtain the greatest benefit from endovascular repair (EVAR), convincing evidence on the medium-long term effect is lacking. The aim of this study was to compare and summarize published results of rAAA that underwent EVAR with open surgical repair (OSR). Methods A search of publicly published literature was performed. Based on an inclusion and exclusion criteria, a systematic meta-analysis was undertaken to compare patient characteristics, complications, short term mortality and medium-long term outcomes. A random-effects model was used to pool the data and calculate pooled odds ratios and weighted mean differences. A quantitative method was used to analyze the differences between these two methods. Results A search of the published literature showed that fourteen English language papers comprising totally 1213 patients with rAAA (435 EVAR and 778 OSR) would be suitable for this study. Furthermore, 13 Chinese studies were included, including 267 patients with rAAA totally, among which 238 patients received operation. The endovascular method was associated with more respiratory diseases before treatment (OR=1.81, P=0.01), while there are more patients with hemodynamic instability before treatment in OSR group (OR=1.53, P=0.031). Mean blood transfusion was 1328 ml for EVAR and 2809 ml for OSR (weighted mean difference (WMD) 1500 ml, P=0.014). The endovascular method was associated with a shorter stay in intensive care (WMD 2.34 days, P <0.001) and a shorter total post-operative stay (WMD 6.27 days, P <0.001). The pooled post-operative complication rate of respiratory system and visceral ischemia seldom occurred in the EVAR group (OR=0.48, P <0.001 and OR=0.28, P=0.043, respectively). The pooled 30-day mortality was 25.7% for EVAR and 39.6% for OSR, and the odds ratio was 0.53 (95% confidence interval (CI) 0.41?0.70, P <0.001). There was not, however, any significant reduction in the medium-long all-cause mortality rate (HR=1.13, P=0.381) and re-intervention rate (OR= 2.19, P=0.243) following EVAR. In EVAR group, nevertheless, incidence of type I endoleak was significantly lower than type II endoleak (OR=0.33, P=0.039) at late follow-up period. Conclusions On the basis of this systematic review, rAAA EVAR results in less blood use for transfusion, shorter operation time, shorter intensive care unit and hospital stays, and lower 30-day mortality. However, in the medium-long term, it is not associated with a reduction in all-cause mortality.
来源 Chinese Medical Journal ,2013,126(24):4771-4779 【核心库】
DOI 10.3760/cma.j.issn.0366-6999.20122076
关键词 aortic aneurysm ; abdominal ; aortic rupture ; endovascular procedures ; medium-long term effect ; meta-analysis
地址

1. Department of Vascular and Thyroid Surgery, the First Hospital of China Medical University, Liaoning, Shenyang, 110001  

2. Department of Vascular Intervention, the First Hospital of China Medical University, Liaoning, Shenyang, 110001

语种 英文
文献类型 研究性论文
ISSN 0366-6999
学科 医药、卫生
基金 国家自然科学基金 ;  the Department of Education of Liaoning Province (Key Laboratory Project) ;  Ministry of Education of China (Key Research Project of Science and Technology)
文献收藏号 CSCD:5008028

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