European Journal of Vascular & Endovascular Surgery
Volume 33, Issue 2 , Pages 154-171, February 2007

Systematic Review and Meta-analysis of 12 Years of Endovascular Abdominal Aortic Aneurysm Repair

  • S.C. Franks

      Affiliations

    • Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
    • Corresponding Author InformationCorresponding author. Dr. S. Franks, University of Leicester Vascular Surgery Group, Robert Kilpatrick Building, Leicester Royal Infirmary, Leicester LE2 7LX, UK.
    • ,
  • A.J. Sutton

      Affiliations

    • Department of Health Sciences, University of Leicester, Leicester, UK
    • ,
  • M.J. Bown

      Affiliations

    • Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
    • ,
  • R.D. Sayers

      Affiliations

    • Department of Cardiovascular Sciences, University of Leicester, Leicester, UK

Accepted 3 October 2006. published online 14 December 2006.

Background

Endovascular repair (ER) of abdominal aortic aneurysm (AAA) is a new technique, and reported rates of endoleak, conversion to open repair, rupture and mortality vary widely. The aim of this study was to estimate these rates from the published data, and examine how this has changed as more patients have undergone ER.

Methods

A systematic review and meta-analysis of publications identified through searches of the electronic databases EMBASE and Medline. All publications quoting endoleak, conversion to open repair, rupture and mortality rates for a series of patients undergoing ER were included.

Results

163 studies pertaining to 28,862 patients undergoing ER were identified as relevant for the review and meta-analysis. The pooled estimate for operative mortality was 3.3% (95% confidence interval 2.9 to 3.6%). The pooled estimate for type 1 endoleaks was 10.5% (95% confidence interval 9.0 to 12.1%), with an annual rate of 8.4% (95% confidence interval 5.7% to 12.2%). The pooled estimate of type 2,3 and 4 endoleaks was 13.7% (95% confidence interval 12.3 to15.3%), with an annual rate of 10.2% (95% confidence interval 7.4% to 14.1%). The pooled estimate for primary conversion to open repair was 3.8% (95% confidence interval 3.2 to 4.4%), and for secondary conversion to open repair 3.4% (95% confidence interval 2.8 to 4.2%). The pooled estimate for post-operative rupture was 1.3% (95% confidence interval 1.1 to 1.7%), with an annual rupture rate of 0.6% (95% confidence interval 0.5% to 0.8%). Multivariate meta-regression analysis showed that rates of operative mortality, post-operative rupture and total number of endoleaks all fell significantly (p<0.05) over time.

Conclusions

This study demonstrates a low mortality and a gradual reduction in vascular morbidity and mortality associated with endovascular repair since it was first introduced.

Keywords: Abdominal aortic aneurysm (AAA), Endovascular repair, Meta-analysis

 

PII: S1078-5884(06)00584-3

doi:10.1016/j.ejvs.2006.10.017

European Journal of Vascular & Endovascular Surgery
Volume 33, Issue 2 , Pages 154-171, February 2007

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