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Individual-patient meta-analysis of three randomized trials comparing endovascular versus open repair for ruptured abdominal aortic aneurysm

2015; Oxford University Press; Volume: 102; Issue: 10 Linguagem: Inglês

10.1002/bjs.9852

1365-2168

Michael Sweeting, Ron Balm, Pascal Desgranges, Pinar Ulug, Janet T. Powell, Ron Balm, Mark J.W. Koelemay, Mirza M. Idu, C. Kox, D.A. Legemate, L.C. Huisman, M.C. Willems, Jim A. Reekers, Otto M. van Delden, Krijn P. van Lienden, L.L. Hoornweg, J.J. Reimerink, S.C. van Beek, A.C. Vahl, V. J. Leijdekkers, Hans Bosma, Alexander D. Montauban van Swijndregt, C de Vries, Victor P. M. van der Hulst, Jan Peringa, J. G. A. M. Blomjous, M.J. Visser, F.H.W.M. van der Heijden, Willem Wisselink, Arjan W.J. Hoksbergen, Jan D. Blankensteijn, M T J Visser, H.M.E. Coveliers, J.H. Nederhoed, F.G. van den Berg, Bram B. van der Meijs, Mijntje L.P. van den Oever, Rutger J. Lely, Martijn R. Meijerink, A Voorwinde, Jan M. Ultee, R.C. van Nieuwenhuizen, Boudewijn J. Dwars, T O M Nagy, P L Tolenaar, Arno M. Wiersema, James A. Lawson, P.J. van Aken, A A Stigter, Theodore A.A. van den Broek, G.A. Vos, W. Mulder, R.P. Strating, D. Nio, G.J. Akkersdijk, A. van der Elst, P van Exter, Pascal Desgranges, J-P Becquemin, Éric Allaire, Frédéric Cochennec, J. Marzelle, Nicolas Louis, J. Schneider, Michał Majewski, Yves Castier, Guy Lesèche, Febin Francis, Éric Steinmetz, J-P Berne, Claire Favier, Stéphan Haulon, Mohamed Koussa, Richard Azzaoui, D Piervito, Yves Alimi, Mourad Boufi, Olivier Hartung, P Cerquetta, Philippe Amabile, Philippe Piquet, J. Penard, Matthew DeMasi, Pierre Alric, Ludovic Canaud, J-P Berthet, Pierre Julia, J.-N. Fabiani, Jean-Marc Alsac, Pierre Gouny, Ali Badra, J Braesco, J-P Favre, J-N Albertini, Robert Martinez, Réda Hassen‐Khodja, Michel Batt, E Jean, Miguel Sosa, Serge Declémy, Laurence Destrieux‐Garnier, Patrick Lermusiaux, Patrick Feugier, Janet T. Powell, Ray Ashleigh, Manuel Gomes, Roger M. Greenhalgh, Richard Grieve, R.J. Hinchliffe, Michael Sweeting, M.M. Thompson, Simon G. Thompson, Pinar Ulug, N.J.W. Cheshire, J R Boyle, Ferdinand Serracino‐Inglott, John Smyth, M.M. Thompson, R.J. Hinchliffe, Rachel E. Bell, N. Wilson, Matthew J. Bown, Martin Dennis, Meryl Davis, Ray Ashleigh, Simon Howell, Mike Wyatt, D. Valenti, Paul Bachoo, Paul M. Walker, Shane T. MacSweeney, Jonathan N. Davies, D Rittoo, S D Parvin, W Yusuf, Colin Nice, Ian Chetter, Andrew Howard, P Chong, R. Bhat, David McLain, Andrew C. Gordon, I F Lane, Simon Hobbs, Woolagasen Pillay, Timothy Rowlands, A El-Tahir, John Asquith, S Cavanagh, Luc Dubois, T.L. Forbes,

Abdominal Surgery and Complications

The benefits of endovascular repair of ruptured abdominal aortic aneurysm remain controversial, without any strong evidence about advantages in specific subgroups.An individual-patient data meta-analysis of three recent randomized trials of endovascular versus open repair of abdominal aortic aneurysm was conducted according to a prespecified analysis plan, reporting on results to 90 days after the index event.The trials included a total of 836 patients. The mortality rate across the three trials was 31.3 per cent for patients randomized to endovascular repair/strategy and 34.0 per cent for those randomized to open repair at 30 days (pooled odds ratio 0.88, 95 per cent c.i. 0.66 to 1.18), and 34.3 and 38.0 per cent respectively at 90 days (pooled odds ratio 0.85, 0.64 to 1.13). There was no evidence of significant heterogeneity in the odds ratios between trials. Mean(s.d.) aneurysm diameter was 8.2(1.9) cm and the overall in-hospital mortality rate was 34.8 per cent. There was no significant effect modification with age or Hardman index, but there was indication of an early benefit from an endovascular strategy for women. Discharge from the primary hospital was faster after endovascular repair (hazard ratio 1.24, 95 per cent c.i. 1.04 to 1.47). For open repair, 30-day mortality diminished with increasing aneurysm neck length (adjusted odds ratio 0.69 (95 per cent c.i. 0.53 to 0.89) per 15 mm), but aortic diameter was not associated with mortality for either type of repair.Survival to 90 days following an endovascular or open repair strategy is similar for all patients and for the restricted population anatomically suitable for endovascular repair. Women may benefit more from an endovascular strategy than men and patients are, on average, discharged sooner after endovascular repair.