A Comparison of Endovascular Aneurysm Repair and Open Repair for Ruptured Aortic Abdominal Aneurysms

Purpose: Management modalities of ruptured abdominal aortic aneurism (AAA) include ruptured open aneurysm repair (rOAR) and ruptured endovascular aneurysm repair (rEVAR). Currently, there is no evidence to favor one of the modalities over the other. In this study, we aim to systematically review all the previously published randomized controlled trials (RCTs) that compared rOAR and rEVAR in all aspects of management of rAAA from data that can be found within studies from the current literature.

Materials and Methods: A systematic search was performed in the following databases: PubMed, Scopus, Web of Science, Google Scholar, Clinical trials, the International Standard Randomized Controlled Trial Number, and the Cochrane Central Register of Controlled Trials with all the potentially relevant keywords that were adjusted to meet the search strategy for each database to collect all the relevant studies that were published up to January 2021. We included all previous RCTs which compared EVAR and OAR in managing rAAA. If a study did not meet these criteria, it was excluded.

Results: A total of 15 studies were identified through our comprehensive search. Among these studies, two represented the Amsterdam Acute Aneurysm (AJAX) trial collaborators, four represented the EVAR trial collaborators, and five represented the IMPROVE trial collaborators. The AJAX trial concluded that both modalities were almost similar in all-cause mortality and occurrence of complications, however, patients in the EVAR group required more re-interventions than patients in the OAR one. In the EVAR trial, the short-term outcomes indicated that EVAR is better in obtaining lower mortality rates while the long-term outcomes favored OAR over EVAR. Besides, the authors suggested that life-long surveillance might be needed for both modalities to avoid potential complications. In the IMPROVE studies, EVAR is not superior regarding the 1-year survival rate but is cost-effective, reduces hospital stay and improves QoL, and is superior on a sort-term basis regarding mortality and blood loss. Cost-effectiveness favors EVAR due to the prolonged hospital stays in OAR patients according to some studies, while others favored OAR as patients with EVAR are more likely to have re-interventions later in their life.

Conclusion: No consensus has been found to favor one of the modalities over the other. However, trials seem to favor EVAR on a short-term basis, while OAR is superior regarding the long-term outcomes.

 

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Artikel online veröffentlicht:
02. April 2024