Meta‐analysis of long‐term survival after elective endovascular or open repair of abdominal aortic aneurysm

• Published in: British journal of surgery 2019-04, Vol.106 (5), p.523-533
• Main Authors: Bulder, R. M. A., Bastiaannet, E., Hamming, J. F., Lindeman, J. H. N.
• Format: Article
• Language: English
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1002/bjs.11123

Background Endovascular aneurysm repair (EVAR) has become the preferred strategy for elective repair of abdominal aortic aneurysm (AAA) for many patients. However, the superiority of the endovascular procedure has recently been challenged by reports of impaired long‐term survival in patients who underwent EVAR. A systematic review of long‐term survival following AAA repair was therefore undertaken. Methods A systematic review was performed according to PRISMA guidelines. Articles reporting short‐ and/or long‐term mortality of EVAR and open surgical repair (OSR) of AAA were identified. Pooled overall survival estimates (hazard ratios (HRs) with corresponding 95 per cent c.i. for EVAR versus OSR) were calculated using a random‐effects model. Possible confounding owing to age differences between patients receiving EVAR or OSR was addressed by estimating relative survival. Results Some 53 studies were identified. The 30‐day mortality rate was lower for EVAR compared with OSR: 1·16 (95 per cent c.i. 0·92 to 1·39) versus 3·27 (2·71 to 3·83) per cent. Long‐term survival rates were similar for EVAR versus OSR (HRs 1·01, 1·00 and 0·98 for 3, 5 and 10 years respectively; P = 0·721, P = 0·912 and P = 0·777). Correction of age inequality by means of relative survival analysis showed equal long‐term survival: 0·94, 0·91 and 0·76 at 3, 5 and 10 years for EVAR, and 0·96, 0·91 and 0·76 respectively for OSR. Conclusion Long‐term overall survival rates were similar for EVAR and OSR. Available data do not allow extension beyond the 10‐year survival window or analysis of specific subgroups. This systematic review and meta‐analysis confirms the superior 30‐day survival after endovascular repair (EVAR) and shows equal long‐term survival for EVAR and open surgical repair (OSR) at 3‐, 5‐ and 10‐year follow‐up when corrected for age differences. Moreover, both patients undergoing EVAR and those having OSR showed a progressively impaired relative survival during follow‐up. Equivalent out to 10 years