Mortality rate in endovascular aortic repair versus open surgical repair in patients with intact abdominal aortic aneurysm

Abstract

Topic overview: Up until 1990, abdominal aortic aneurysm (AAA) was repaired using open surgical repair (OSR), but since then, endovascular aneurysm repair (EVAR) has gained popularity. This dissertation compares long-term survival of patients who underwent elective surgical repair either by open or endovascular repair. The aim is to identify which of the two offers the best long-term survival benefits. Research question: In patients with intact AAA needing surgical repair, is EVAR better than OSR in reducing the mortality rates? PICO elements: The population consisted of patients with intact AAA, where EVAR was set as the intervention, while OSR was the studied comparison. The outcome of interest was the least mortality rate. Inclusion and exclusion criteria: Articles from 1990 onwards were considered; however, they were restricted to English. Both males and females with intact AAA were included. Studies which investigated only short-term mortality and only all-cause mortality were excluded. For studies to be considered, they had to be either randomised control trials (RCT) or systematic reviews and meta-analyses of RCTs. Outcome: Four data bases and two search engines were utilised to assess which of the two surgical repairs offers the better long-term survival. From the literature search, five articles were retrieved. Appraisal methods used: PRISMA, CASP checklists and the hierarchy of evidence pyramid were utilised for this dissertation. Results: EVAR offers better short-term mortality but loses its advantage in the long-term. In some studies, it was reported that OSR offers better survival rates when compared to EVAR. Conclusion: EVAR does not offer better survival benefits in the long-term when compared to OSR. Implications and recommendations for practice: Lifelong surveillance should be offered to patients who underwent EVAR repair, as the treatment is associated with more complications in the long run. New trials should be performed using the latest generation of EVAR stent grafts, and studies should include more females.