Objective
Methods
Results
Conclusion
Keywords
Introduction
- Indrakusuma R.
- Jalalzadeh H.
- Vahl A.C.
- Koelemay M.J.W.
- Balm R.
- Waton S.
- Johal A.
- Heikkila K.
- Cromwell D.
- Loftus I.
Methods
- Deeks J.J.
- Higgins J.P.T.
- Altman D.G.
Search strategy, selection, and data extraction
Wells G, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for Assessing The Quality Of Nonrandomised Studies In Meta-Analyses. Ottawa Hospital Research Institute. Available at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp [Accessed 3 Feb 2021].
Inclusion criteria | Exclusion criteria |
---|---|
Operation date year 2000 or later | Inclusion of AAA repair before 2000 |
Age ≥ 55 y | Studies of selected subgroups, thoracic aortic disease, or syndromic pathologies (e.g., Marfan syndrome) |
Clinical studies of AAA repairs including ≥ 50 women | Review articles, editorials, case reports, biomarker, pathobiology, and animal studies |
Separate reporting of open repair and endovascular repair | Combined reporting of AAA outcomes (open and endovascular and/or other vascular and/or other surgical outcomes) |
Separate reporting of outcomes from intact AAA cases | Combined reporting of outcomes from intact and ruptured AAA cases |
Studies including patients with infrarenal, juxtarenal, pararenal, or suprarenal AAA | Studies of thoraco-abdominal and isolated iliac aneurysms |
Studies including endovascular aneurysm repair, branched, chimney, and fenestrated endografts | Studies of experimental technologies including Nellix and flow modulating stents |
For studies reporting duplicated data, the most recent or most comprehensive publication to be indexed | Significant attrition or insufficient data quality to enable data synthesis (e.g., reporting of hazard ratios alone) |
English language, major European language | Duplicated data (including abstracts and online ahead of print articles, patient series later updated, etc.) |
Not in English or major European language |
Statistical analysis
- Harrer M.
- Cuijpers P.
- Furukawa T.A.
- Ebert D.D.
Results
Study selection

Study | Data source | Study period | OAR in men / women | EVAR in men / women | NO score | Reported variables ∗ Reported outcomes: Mortality: 1a, 30 d; 1b, in hospital; 1c long term. Peri/post-operative complications: 2a, blood transfusion, 2b, arterial injury, 2c, limb ischaemia, 2d, bowel ischaemia, 2e, cardiac, 2f, respiratory, 2g, neurological and 2h, renal complications, 2i, re-intervention and 2j, endoleaks. Duration of treatment: 3a operative time, 3b length of intensive care and 3c hospital stay. Pre-operative comorbidities and risk factors: 4a cardiovascular, 4b, respiratory, 4c, renal, 4d, diabetes, 4e, peripheral vascular disease, 4f, smoker, 4g, comorbidity score. | ||||
---|---|---|---|---|---|---|---|---|---|---|
n | Age–y | AAA diameter–mm | n | Age – y | AAA diameter–mm | |||||
UK | ||||||||||
Desai 2016 8 | HES/ONS (IRAAA) | 2002–2013 (EVAR: 2006–13) | 26 295 / 4 795 | 72 ± 8 /74 ± 8 | 14 741 / 2 036 | 75 ± 7 /77 ± 8 | 8 | 1a,c, 2e–h, 4a-e,g | ||
Lowry 2016 9 | HES/ONS (IRAAA) | 2006–2015 | 18 215 / 2 304 | 76 (70–80) /78 (74–82) | 7 | 1a,c, 3c, 4c–e,g | ||||
Sidloff 2017 3 | NVR/HES (IRAAA) | 2010–2014 | 6 013 / 922 | 72 ± 8 /74 ± 8 | 62 (57–72) /60 (56–67) | 10 452 / 1 306 | 76 ± 8 /78 ± 7 | 60 (57–67) /59 (56–65) | 8 | 1b, 3b–c, 4a–d,f |
Germany | ||||||||||
Trenner 2018 38 | GFSO (IRAAA) | 2005–2013 | 33 815 / 5 208 | 70 (65–75) /72 (67–78) | 40 777 / 4 831 | 73 (68–78) /76 (71–82) | 8 | 1b, 2a 3c, 4a–e,g | ||
Trenner 2020 2 | GFSO (IRAAA) | 2005–2014 | 35 876 / 5 614 | 47 727 / 5 749 | 9 | 1b, 3b, 4a–e | ||||
Behrendt 2021 25 | DAK-G (IRAAA) | 2011–2017 | 3 136/ 770 | 74 (8) / 75 (8) | 8 | 1b, 2a,c–f,h,i, 3c, 4d | ||||
Holland | ||||||||||
Indrakusuma 2019 5
Editor’s Choice - Sex related differences in peri-operative mortality after elective repair of an asymptomatic abdominal aortic aneurysm in the Netherlands: a retrospective analysis of 2013 to 2018. Eur J Vasc Endovasc Surg. 2019; 58: 813-820 | DSAA (IRAAA) | 2013–2018 | 2 056 / 507 | 71 (66–76) /72 (67–77) | 7 581 / 1 155 | 74 (68–79) /76 (66–76) | 8 | 1a, 4a,b | ||
USA | ||||||||||
Mehta 2012 4 | Albany medical college (AAA) | 2002–2009 | 579 / 209 | 70 / 73 | 62 / 58 | 1 248 / 344 | 73 / 75 | 56 / 56 | 7 | 1a, 2a–f,h–j, 3c |
Schermerhorn 2012 32 | Medicare beneficiaries (AAA) | 2008 | 4 115 / 1 764 | 15 590 / 3 657 | 6 | 1a | ||||
Lo 2013 33 | VSGNE (IRAAA) | 2003–2011 | 1 117 / 412 | 61 ± 14 /58 ± 12 | 1 660 / 408 | 57 ± 11 /56 ± 10 | 7 | 1a–c, 2a–f,h–j, 3a–c | ||
Ramanan 2013 6 | NSQIP (AAA) | 2007–2009 | 2 117 / 728 | 8 | 1a | |||||
Skibba 2015 35 | Johnson City Medical Center (IRAAA) | 2000–2013 | 371 / 104 | 545 / 83 | 5 | 1b | ||||
Chung 2015 19 | Mount Sinai Hospital (IRAAA) | 2003–2012 | 617 / 121 | 75 ± 8 /78 ± 8 | 5 | 1a, 2a–c,f, 3c | ||||
Ultee 2016 23 | VSGNE (AAA) | 2003–2014 | 1 571 / 625 | 3 583 / 889 | 9 | 2d | ||||
Nevidomskyte 2016 36 | VISCOAP (IRAAA) | 2010–2013 | 152 / 56 | 696 / 160 | 7 | 1a, 2a–b,i–j, 3c | ||||
Deery 2016 7 | NSQIP (IRAAA) | 2011–2014 | 629 / 207 | 68 (63–75) /74 (68–79) | 59 (52–70) /56 (52–62) | 4 727 / 1 048 | 74 (68–80) /77 (71–83) | 55 (51–61) /53 (50–60) | 8 | 1a, 2a, c–e,g–i, 3a–c, 4b,d,f,g |
Locham 2019 39 | SVS-VQI (AAA) | 2003–2018 | 6 798 / 2 465 | 69 ± 9 /71 ± 9 | 62 ± 15 /58 ± 12 | 33 164 / 7 786 | 73 ± 9 /75 ± 9 | 57 ± 16 /54 ± 11 | 8 | 1a, 2a,e,h j, 3a,c, 4a–f |
Schutze 2019 45 | The Heart Hospital Baylor Plano (IRAAA) | 2003–2009 | 278 / 58 | 73 ± 9 /77 ± 9 | 54 ± 12 /52 ± 10 | 7 | 1c, 2i, 4a–d,f | |||
deGuerre 2020 40 | NSQIP (cAAA) | 2011–2017 | 950 / 310 | 60 (55–68) /57 (52–64) | 740 / 270 | 56 (51–62) /55 (51–60) | 8 | 1a, 2c–e,g–i, 3a | ||
Finland | ||||||||||
Laine 2017 37 | Finnish Institute for Health & Welfare (AAA) | 2000–2014 | 2 898 / 414 | 1 424 / 220 | 9 | 1a | ||||
Sweden | ||||||||||
Mani 2013 34 | Swedvasc (IRAAA) | 2006–2010 | 1 698 / 436 | 1 669 / 329 | 9 | 1a | ||||
Japan | ||||||||||
Hoshina 2017 42 | JACSM (IRAAA) | 2006–2015 | 31 442 / 6 566 | 7 | 1b,c, 2i | |||||
Multinational | ||||||||||
Dubois 2013 41 | Canada ENGAGE (IRAAA) | 2009–2011 | 1 131 / 131 | 73 ± 8 /76 ± 7 | 61 ± 12 /58 ± 10 | 5 | 1a, 2a,d–j, 3a–c, 4a–g | |||
Powell 2017 10 | EVAR -1, DREAM, OVER, ACE (IRAAA) | 2000–2008 | 1 233 / 71 | 1 312 / 77 | 9 | 1a | ||||
Storck 2017 43 | European Ovation registry (IRAAA) | 2011–2013 | 432 / 69 | 73 (46–91) /77 (49–90) | 55 (26–110) /54 (30–82) | 5 | 1c, 2a,i,j, 3c, 4a–d,f,g | |||
Varkevisser 2019 44 | Encore registry (IRAAA) | 2009–2016 | 1 045 / 251 | 73 ± 8 /75 ± 8 | 52 ± 8 /55 ± 10 | 5 | 1c, 2i,j, 3b,c, 4a,b,d–f |
Mortality outcomes
- Indrakusuma R.
- Jalalzadeh H.
- Vahl A.C.
- Koelemay M.J.W.
- Balm R.

- Indrakusuma R.
- Jalalzadeh H.
- Vahl A.C.
- Koelemay M.J.W.
- Balm R.
- Indrakusuma R.
- Jalalzadeh H.
- Vahl A.C.
- Koelemay M.J.W.
- Balm R.

- Indrakusuma R.
- Jalalzadeh H.
- Vahl A.C.
- Koelemay M.J.W.
- Balm R.

Peri-operative outcomes
Post-operative in hospital/30 day complications

Endograft complications
Assessment of bias and sensitivity analyses
Discussion
- Cohnert T.
- Konstantiniuk P.
- Sieg G.
- Oswald W.
- Portugaller H.
Conflict of interest
Funding
Appendix A. Supplementary data
- Supplementary material: Supplementary figures, tables and text S1-8
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- Extra Caution Required in Elective Abdominal Aortic Aneurysm Repair for WomenEuropean Journal of Vascular and Endovascular SurgeryVol. 62Issue 3
- PreviewPouncey et al. have conducted a relevant meta-analysis comparing the short term outcomes of intact abdominal aortic aneurysm
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