Comparison of Endovascular vs Open Repair for Abdominal Aortic Aneurysm: Mortality and Morbidity Outcomes

Author(s): Marwan Y. Abdulkadder, Roda Rashid Bin Sultan Alshamsi, Hanadi Mohamad Al Hussami, Meera Ahmed Mohamed Othman Ali, Nabaa Shakir Mahmood, Judy Al Hussami, Aisha Rashid Mohamed Binsultan Alshamsi, Reem Ibrahim Ali, Maryam Alyas Ali, Najla Ebrahim Almansoori.

An abdominal aortic aneurysm (AAA) is a clinical emergency that involves local expansion of the abdominal aorta. The management of AAA typically involves two surgical approaches: endovascular aneurysm repair (EVAR) and open surgical repair (OSR). While both outcome and process measures used in this technique are successful, there is continuing controversy about the relative efficacy of the two approaches concerning mortality and morbidity rates. This meta-analysis is, therefore, designed to provide a structured approach through which the mortality and morbidity rates of EVAR and OSR for AAA can be determined.

The MEDLINE, EMBASE, and Cochrane Library databases were searched systematically to extract RCTs and observational studies that compare EVAR and OSR. Eligible trials were required to provide data on perioperative mortality, long-term survival, and significant morbidity, including cardiac, pulmonary, and renal events. Two authors conducted data collection and quality assessment, and a meta-analysis was performed using the random effect model due to variation across various studies. Our results indicate that EVAR has postoperative mortality benefits over OSR, though it is unclear how long these benefits will continue to be beneficial. However, due to endoleaks, EVAR is associated with increased incidence of long-term reintervention.

In contrast, OSR is more durable than MSR and equals or even surpasses the number of reinterventions. However, it has more excellent rates of perioperative morbidity, such as respiratory or cardiac. In subgroup analysis, age, co-morbidities, and aneurysm characteristics are moderators in the treatment results. This meta-analysis has juxtaposed the benefits of EVAR to the risks of OSR in the management of AAA. The results of this study indicate that the key treatment planning factor is patient-specific, and such a general surgical approach should be applied where skillful professionals are available.