A systematic review and meta-analysis of endovascular repair (EVAR) for ruptured abdominal aortic aneurysm

H S Rayt, A J Sutton, N J M London, R D Sayers, M J Bown
European Journal of Vascular and Endovascular Surgery 2008, 36 (5): 536-44

BACKGROUND: Endovascular abdominal aortic aneurysm (EVAR) repair has become a well-established technique in the treatment of elective abdominal aortic aneurysms (AAAs) due to proven benefits in mortality, hospital stay and operation time compared to open repair. The aim of this study was to estimate the mortality rate from EVAR due to ruptured abdominal aortic aneurysm (RAAA).

METHODS AND MATERIALS: A systematic review and meta-analysis of all English language literature with information on mortality rates from EVAR for RAAA was conducted.

RESULTS: The pooled mortality rate from RAAA after EVAR across 31 studies concerning 982 patients was 24% (95% confidence interval (CI) 20-28%). The pooled morbidity from 21 studies was 44% (95% CI 33-55%). The average procedure time was 155.1 min, with an intra-operative blood loss of 523 ml and hospital stay of 10.1 days. There is evidence of publication bias suggesting the mortality rate may be under-estimated.

CONCLUSIONS: Mortality from EVAR for RAAA appears to be lower than that which is reported for open repair of RAAA. However, the high level of publication bias cannot be ignored and may actually indicate higher mortality rates.

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