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Evidence-based Practice |
1 From the Dept of Radiology, Massachusetts General Hospital, Harvard Medical School, Zero Emerson Pl, Ste 2H, Boston, MA 02114 (M.E.A.P.M.A., J.L.B., E.F.H., G.S.G.); Depts of Radiology (M.E.A.P.M.A., M.G.M.H.) and Epidemiology and Biostatistics (M.E.A.P.M.A., J.L.B., M.G.M.H.), Erasmus Univ Med Ctr, Rotterdam, the Netherlands; and Dept of Health Policy and Management, Harvard School of Public Health, Boston, Mass (M.G.M.H., G.S.G.). From the 2001 RSNA scientific assembly. Received Oct 12, 2001; revision requested Dec 26; revision received Jan 15, 2002; accepted Mar 12. M.E.A.P.M.A. supported by grants from Foundation Fundatie van de Vrijvrouwe van Renswoude, Foundation Gerrit Jan Mulder Stichting, Netherland-America Foundation, Netherlands Heart Foundation, Foundation Stichting Dr Hendrik Muller’s Vaderlandsch Fonds, Foundation Stichting Jo Kolk Studiefonds, Talentenprogramma Award for Talented Students by the Dutch Ministry of Education, Foundation Van Walree Fonds of the Royal Netherlands Academy of Arts and Sciences, Foundation Vereniging Trustfonds Erasmus Univ Rotterdam, and VSB Foundation. J.L.B., E.F.H., G.S.G. supported in part by the U.S. Dept of the Army under DAMD 17-99-2-9001. The information presented does not necessarily represent the position of the government, and no official endorsement should be inferred. Address correspondence to G.S.G.
PURPOSE: To summarize and compare published short-term results of elective endovascular and open surgical repair of abdominal aortic aneurysms.
MATERIALS AND METHODS: A MEDLINE search of the English literature was performed. Studies with at least 10 patients in each treatment group were included if they reported patient characteristics, complications, and mortality. Two reviewers independently extracted the data. A random-effects model was used to pool the data and calculate pooled odds ratios (endovascular vs open surgical repair).
RESULTS: Nine studies were included, reporting results of 1,318 procedures (687 endovascular repair and 631 open surgical repair). Mean blood loss was 456 mL for endovascular repair and 1,202 mL for open surgical repair (P = .003). On average, patients undergoing endovascular repair spent 0.5 days in the intensive care unit and 3.9 days in the hospital, and patients undergoing open surgical repair spent 2.2 days (P = .04) in the intensive care unit and 10.3 days (P = .02) in the hospital. The pooled 30-day-mortality was 0.03 for endovascular repair (95% CI: 0.02, 0.04) and 0.04 for open surgical repair (95% CI: 0.00, 0.07) (P = .03), and the odds ratio was 0.55 (95% CI: 0.33, 0.92). The pooled local and/or vascular complication rate was 0.16 for endovascular repair (95% CI: 0.06, 0.25) and 0.12 for open surgical repair (95% CI: 0.06, 0.18) (P = .46), and the odds ratio was 0.97 (95% CI: 0.62, 1.54). The pooled systemic and/or remote complication rate was 0.17 for endovascular repair (95% CI: 0.09, 0.25) and 0.44 for open surgical repair (95% CI: 0.21, 0.66) (P < .001), and the odds ratio was 0.22 (95% CI: 0.11, 0.45).
CONCLUSION: On the basis of this systematic review, endovascular repair results in less blood loss, shorter intensive care unit and hospital stays, lower 30-day mortality, and lower systemic and/or remote complication rates than those of open surgical repair.
© RSNA, 2002
Index terms: Aneurysm, abdominal, 943.73 • Aneurysm, aortic, 943.73 • Aneurysm, surgery, 943.1268, 943.73 • Data, analysis • Grafts, interventional procedures, 943.1268
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