Radiology
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

DOI: 10.1148/radiol.2451061204
This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Supplemental Tables
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Visser, J. J.
Right arrow Articles by Bosch, J. L.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Visser, J. J.
Right arrow Articles by Bosch, J. L.
(Radiology 2007;245:122-129.)
© RSNA, 2007

Evidence-based Practice

Ruptured Abdominal Aortic Aneurysms: Endovascular Repair versus Open Surgery—Systematic Review1

Jacob J. Visser, MSc, Marc R. H. M. van Sambeek, MD, PhD, Taye H. Hamza, MSc, M. G. Myriam Hunink, MD, PhD, and Johanna L. Bosch, PhD

1 From the Departments of Epidemiology and Biostatistics (J.J.V., T.H.H., M.G.M.H., J.L.B.), Radiology (J.J.V., M.G.M.H., J.L.B.), and Surgery (J.J.V., M.R.H.M.v.S.), Erasmus MC, Dr Molewaterplein 40, Room Ee21-40B, 3015 GD Rotterdam, the Netherlands; Department of Health Policy and Management, Harvard School of Public Health, Boston, Mass (M.G.M.H.); and Institute of Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.L.B.). Received July 12, 2006; revision requested September 14; revision received November 13; accepted December 18; final version accepted February 20, 2007. Supported in part by an Erasmus University Medical Center Health Care Efficiency grant and an unrestricted educational grant from the Lijf en Leven Foundation. Address correspondence to J.L.B. (e-mail: j.l.bosch{at}erasmusmc.nl).

Purpose: To perform a systematic review of studies in which endovascular repair was compared with open surgery in the treatment of patients with a ruptured abdominal aortic aneurysm (AAA).

Materials and Methods: A search of the English-language literature from January 1994 until March 2006 was performed. Inclusion criteria for studies were that they were about a comparison between patients who underwent endovascular repair and patients who underwent open surgery, that each treatment group included at least five patients, that information about patients' hemodynamic condition at presentation was reported, and that 30-day mortality was reported for each treatment group. Two reviewers independently extracted the data, and discrepancies were resolved by an arbiter. Random-effects models and meta-regression analysis were used to calculate crude and adjusted odds ratios (ORs) for endovascular repair versus open surgery.

Results: Ten studies, in which the results of 478 procedures (n = 148 for endovascular repair, n = 330 for open surgery) were reported, met the inclusion criteria. All studies were observational; no randomized controlled trials were found. The pooled 30-day mortality was 22% (95% confidence interval [CI]: 16%, 29%) for endovascular repair and 38% (95% CI: 32%, 45%) for open surgery. The pooled rate for total systemic complications was 28% (95% CI: 17%, 48%) for endovascular repair and 56% (95% CI: 37%, 85%) for open surgery. The crude OR for 30-day mortality for endovascular repair compared with open surgery was 0.45 (95% CI: 0.28, 0.72). After adjustment for patients' hemodynamic condition, the OR was 0.67 (95% CI: 0.31, 1.44).

Conclusion: In this systematic review, after adjustment for patients' hemodynamic condition at presentation, a benefit in 30-day mortality for endovascular repair compared with open surgery for patients with a ruptured AAA was observed, but it was not statistically significant.

Supplemental material: http://radiology.rsnajnls.org/cgi/content/full/245/1/122/DC1

© RSNA, 2007