Endovascular versus open abdominal aortic aneurysm repair in young patients- A meta-analysis

Postgraduate Thesis uoadl:3221531 7 Read counter

Unit:
Speciality Endovascular Techniques
Library of the School of Health Sciences
Deposit date:
2022-06-22
Year:
2022
Author:
Gavalaki Aikaterini
Supervisors info:
Γεώργιος Γερουλάκος, Καθηγητής, Ιατρική Σχολή ΕΚΠΑ
Ιωάννης Κακίσης, Καθηγητής, Ιατρική Σχολή ΕΚΠΑ
Αχιλλέας Χατζηϊωάνου, Καθηγητής, Ιατρική Σχολή ΕΚΠΑ
Original Title:
Endovascular versus open abdominal aortic aneurysm repair in young patients- A meta-analysis
Languages:
English
Translated title:
Endovascular versus open abdominal aortic aneurysm repair in young patients- A meta-analysis
Summary:
Introduction
The advantages of endovascular repair (EVAR) of abdominal aortic aneurysm
(AAA) over open surgical repair (OSR) are well described, regarding lower perioperative
morbidity and mortality, reduced length of stay and earlier recovery. In
the long term, the low overall mortality associated with open repair surgery has to
be balanced against the lower early mortality but questionable durability of EVAR.
This fact, along with the higher need for re-interventions, creates controversy on
whether EVAR is a suitable technique in younger patients. However, accumulated
experience, rapid technological improvement, newer devices, and better patient
selection reinforce the assumption that long-term outcomes of EVAR should be
improved and at least, similar to OSR. In this study, clinical data on younger
patients were analyzed to investigate the results of EVAR versus OSR in younger
patients with AAA.
Patients and Methods
The MEDLINE, CENTRAL, and EMBASE databases were searched from January
2000 to March 2022. Peri-operative (30-day mortality and morbidity, length of
hospitalization) and long-term outcomes (long-term mortality, re-intervention rate)
were compared between young patients undergoing EVAR and OSR. For the meta-analysis
of comparative studies, the random effects model was used to calculate
combined overall effect sizes of pooled data. Nine observational retrospective
studies (8 single-center and 1 multi-center), five administrative databases and one
randomized control trial were included in the analysis. Data are presented as the
odds ratio (OR) or mean difference (MD) with 95% confidence interval (CI).
Results
EVAR was associated with a decreased risk of 30-day mortality (OR 0.24, 95% CI
0.16 – 0.34; P<0.00001, shorter length of hospitalization (MD -4.44 days, 95% CI
4.79 – 4.09; P<0.00001), significantly lower need of intensive care unit (ICU) (OR
0.02, 95% CI 0.01 – 0.10; P<0.00001) and shorter stay in the ICU (MD -1.06 days,
95% CI -1.76 – -0.35; P=0.003). Moreover, a potential long-term survival benefit of
either the procedures failed to reach statistically significant difference (OR 1.00,
95% CI 0.41 – 2.44; P=1.00), whereas the overall re-interventions were more
common among EVAR patients but the difference was not statistically significant
(OR 1.64, 95% CI 0.90 – 2.94; P=0.11).
Conclusion
Emerging evidence supports beneficial short-term and similar long-term outcomes
of EVAR for AAA as compared with OSR in young patients, setting it as a safe
alternative, on, however, strict anatomical terms. Future randomized trials are
necessary, providing separate data on young patients, following strictly the
indications for use, regarding EVAR, in order to elucidate the comparative effect of
EVAR and OSR in this subgroup of patients.
Main subject category:
Health Sciences
Keywords:
Endovascular repair, Abdominal aortic aneurysm, Young, Meta-analysis
Index:
No
Number of index pages:
0
Contains images:
Yes
Number of references:
77
Number of pages:
52
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