Universität zu Köln

Luebke, T. and Brunkwall, J. (2014). Metaanalysis of EVAR versus Open Repair for Patients undergoing Elective Repair of Abdominal Aortic Aneurysms. Zent.bl. Chir., 139 (5). S. 552 - 562. STUTTGART: GEORG THIEME VERLAG KG. ISSN 1438-9592

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Abstract

Introduction: Elective endovascular abdominal aneurysm repair (EVAR) has become established in the past 20 years as a therapy option for infrarenal abdominal aortic aneurysms (AAA). Even so the benefits of EVAR over open aneurysm repair (OR) are still being discussed controversially. Materials and Methods: A random effects meta-analysis model was used to compare the surgical outcome of EVAR with that of open operations. The end points were evaluated comparatively by use of the Peto odds ratio (Peto OR) and weighted mean differences (WMD). Four prospective randomised studies (EVAR-1, DREAM, OVER, ACE) with a total of 2747 patients (EVAR 1381, OR 1366) were included in the metaanalysis. Results: In comparison to OR, EVAR was associated with a significantly reduced 30-day mortality rate (Peto OR: 0.373; p < 0.001). In addition, there was a statistically significant advantage of EVAR over OR with regard to aneurysm-associated mortality (Peto OR: 0.589, p = 0.013) and the length of hospital stay (SD in mean: -0.494; p < 0.001). In contrast OR exhibited a lower re-intervention rate than EVAR (Peto OR: 1.843, p < 0.001). On consideration of long-term survival (Peto OR: 0,977; p = 0.826) and health-related quality of life there were no statistically significant differences between the two therapeutic options (SD in mean: -0.032, p = 0.481). Conclusions: In spite of the clinical heterogeneity of the studies included in the metaanalysis, the data indicate that EVAR has a marked benefit with regard to surgical mortality. In the long-term course this advantage in survival is lost but this is not due to the aneurysm-associated mortality.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Luebke, T. UNSPECIFIED UNSPECIFIED UNSPECIFIED Brunkwall, J. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-427061
DOI:	10.1055/s-0032-1328356
Journal or Publication Title:	Zent.bl. Chir.
Volume:	139
Number:	5
Page Range:	S. 552 - 562
Date:	2014
Publisher:	GEORG THIEME VERLAG KG
Place of Publication:	STUTTGART
ISSN:	1438-9592
Language:	German
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language ENDOVASCULAR REPAIR Multiple languages Surgery Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/42706