Open Repair of Descending Thoracic and Thoracoabdominal Aortic Aneurysms: A Meta-Analysis

2020 ◽  
Vol 110 (6) ◽  
pp. 1941-1949 ◽  
Author(s):  
Faiza M. Khan ◽  
Ajita Naik ◽  
Irbaz Hameed ◽  
N. Bryce Robinson ◽  
Cristiano Spadaccio ◽  
...  
2018 ◽  
Vol 68 (6) ◽  
pp. 1936-1945.e5 ◽  
Author(s):  
Rodolfo V. Rocha ◽  
Jan O. Friedrich ◽  
Malak Elbatarny ◽  
Bobby Yanagawa ◽  
Mohammed Al-Omran ◽  
...  

2008 ◽  
Vol 48 (1) ◽  
pp. 227-236 ◽  
Author(s):  
Umar Sadat ◽  
Jonathan R. Boyle ◽  
Stewart R. Walsh ◽  
Tjun Tang ◽  
Kevin Varty ◽  
...  

Vascular ◽  
2021 ◽  
pp. 170853812110251
Author(s):  
Hatim Alsusa ◽  
Abbas Shahid ◽  
George A Antoniou

Background Optimal management of ruptured abdominal aortic aneurysms (rAAA) has been heavily debated in the literature. The aim of this review is to assess comparative outcomes from propensity-matched studies of endovascular versus open for rAAA. Methods Electronic databases (MEDLINE and Embase) were searched in January 2021 using the Healthcare Databases Advanced Search interface. Eligible studies compared endovascular versus open repair for rAAA using propensity-matched cohorts. Pooled estimates of perioperative outcomes were calculated using odds ratio (OR) or mean difference (MD) and 95% confidence interval (CI) using the random-effects model. Time-to-event data meta-analysis was conducted using the inverse-variance method and reported as summary hazard ratio (HR) and associated 95% CI. The quality of evidence was graded using a system developed by the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) working group. Results Six studies published between 2010 and 2020 were selected for qualitative and quantitative synthesis, reporting a total of 6731 patients. The odds of perioperative mortality after endovascular aneurysm repair (EVAR) were significantly lower than after open surgical repair (OSR) (OR 0.52, 95% CI 0.41–0.65). The hazard of overall mortality during follow-up was lower, although not significantly, after EVAR than after OSR (HR 0.79, 95% CI 0.62–1.01). The odds of acute kidney injury and early aneurysm-related reintervention were both significantly lower after EVAR than after OSR (OR 0.34, 95% CI 0.14–0.78 and OR 0.57, 95% CI 0.33–0.98, respectively). Patients treated with EVAR stayed in hospital for significantly less time than those treated with OSR (MD −5.13, 95% CI −7.94 to −2.32). The certainty of the body of evidence for perioperative mortality was low and for overall mortality was very low. Conclusion The evidence suggests that EVAR confers a significant benefit on perioperative mortality.


ESC CardioMed ◽  
2018 ◽  
pp. 2579-2582
Author(s):  
Regula S. von Allmen

For uncomplicated abdominal aortic aneurysms (AAAs), small ones (<55 mm in diameter) are generally subject to surveillance, while larger ones (≥55 mm in diameter) should be considered for aneurysm repair. There is no benefit of a timely repair for small AAAs, regardless of repair method and patient age. Aortic aneurysm, however, is a surrogate for cardiovascular morbidity, thus risk factor management and secondary preventive drug treatment is essential in all AAA patients. Several studies have attempted to address the optimal pace for ultrasound surveillance of small aneurysms and based on a recent large meta-analysis, intervals of 3 years, 1 year, and 6 months were proposed for AAAs measuring 30–39, 40–49, and 50–54 mm, respectively. In patients with a large aneurysm, open or endovascular aortic repair (EVAR) is the primary treatment option. The goals for both repair techniques are identical, although the treatment strategy is completely different. During EVAR, the aneurysm is left intact, and the blood flow is excluded from the aneurysm by catheter-based deployment of a stent graft; thus, successful EVAR procedures are bound to specific anatomical conditions. In cases that are anatomically and physiologically eligible for both conventional EVAR and open repair, EVAR was associated with a substantial early survival advantage; this benefit, however, was lost over time. The rate of late rupture was significantly higher after endovascular repair than after open repair. In patients with a ruptured AAA, an individual patient data meta-analysis from three randomized controlled trials reported similar survival to 90 days following an endovascular or open repair strategy.


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