Abstract 10275: Open versus Endovascular Stent Graft Repair of Abdominal Aortic Aneurysms: Meta-Analysis of Prospective Randomized Controlled Trials
Introduction: Endovascular stent graft repair of abdominal aortic aneurysms has gained widespread acceptance as an alternative to open surgical repair with a lower perioperative mortality rate. The intermediate and long-term comparative results of open vs. endovascular repair vary among studies, and we sought to perform a meta-analysis of these studies.
Methods and Results: We performed a meta-analysis of 10 prospective randomized trials in which patients were randomized to either open or endovascular stent graft repair of abdominal aortic aneurysms. Of 2899 aneurysm repairs, 1470 underwent endovascular repair and 1429 were treated by open repair. At 30 days all-cause mortality pooled relative risk was higher in the open group (risk ratio 0.35, 95% CI 0.19 to 0.64). At intermediate follow-up between 30 days and 2 years all-cause mortality the relative risk ratio decreased to 0.78 (95% CI 0.57 to 1.08), and by 3 years it lowered to 0.99 (95% CI 0.85 to 1.15). Aneurysm-related mortality was the same as all-cause mortality at 30 days (risk ratio 0.35, 95% CI 0.19 to 0.64). From 30 days to 2 years aneurysm-related mortality remained higher in the open group (risk ratio 0.46, 95% CI 0.28 to 0.74), and at 3 years it was not significant (RR 1.58, 95% CI 0.20 to 12.74). Reintervention rates were higher in the endovascular group at both 30 day to 2 year intervals (risk ratio 1.48, 95% CI 1.05 to 2.08) and at greater than 3 years (2.54, 95% CI 1.58 to 4.08).
Conclusions: In patients randomized to open or endovascular aneurysm repair, all-cause and aneurysm-related mortality in the 30-day and intermediate post-operative period is higher in patients undergoing open repair. The mortality advantage of endovascular repair diminishes over the long-term period with a subsequent increase in re-intervention. Therefore, in good risk candidates open repair should be considered.
- © 2011 by American Heart Association, Inc.