Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, United States of America.
Department of Medicine, Jacobi Medical Center, New York, NY, United States of America.
Cardiovasc Revasc Med. 2020 Oct;21(10):1253-1259. doi: 10.1016/j.carrev.2020.02.015. Epub 2020 Feb 19.
The aim of this meta-analysis was to investigate whether Endovascular abdominal aortic aneurysm repair (EVAR) is inferior to open surgical repair in terms of adverse events during late follow up, defined as >8 years after the procedure.
EVAR is associated with reduced morbidity and mortality compared to open surgery in the early perioperative period. However, it is unknown whether this pattern remains during long-term follow up >8 years.
A meta-analysis was conducted with the use of random effects modeling. Hazard ratios were calculated for mortality at different time intervals, and risk ratios were calculated in cases where the total number of events was available.
There was no difference in all-cause mortality during follow up of each study (HR: 1.04; 95%CI: 0.93-1.17; I = 16.0%). Subgroup analyses for all-cause mortality at 4 to 8 years of follow up (HR: 1.13; 95%CI: 0.94-1.35; I = 0.0%) and all-cause mortality at follow up >8 years (HR: 1.07; 95%CI: 0.89-0.28; I = 36.6%) also did not show any significant difference between the two approaches. The risks of aneurysm-related mortality and aneurysm rupture were similar during follow-up. However, the cumulative risk for reintervention during follow up was greater in the EVAR group (RR: 2.18; 95%CI: 1.50-3.17; I = 76.1%) and occurred in 29% vs 15% of patients in the EVAR vs surgery groups respectively.
EVAR and open surgical repair of AAA are equally safe and have no difference in all-cause mortality. However, endovascular repair is associated with an increased need for re-intervention. Emerging technology in endovascular devices will likely further improve the outcomes of EVAR. Subject codes: Meta-analysis; aneurysm; atherosclerosis; complications.
本荟萃分析旨在探讨血管内腹主动脉瘤修复术（EVAR）在晚期随访期间（即术后 8 年以上）不良事件方面是否劣于开放手术。
与开放手术相比，EVAR 在围手术期早期具有降低发病率和死亡率的优势。然而，目前尚不清楚这种模式在 8 年以上的长期随访中是否仍然存在。
使用随机效应模型进行荟萃分析。计算了不同时间间隔死亡率的危险比，并在可获得总事件数的情况下计算了风险比。
在每个研究的随访期间，全因死亡率无差异（HR：1.04；95%CI：0.93-1.17；I=16.0%）。亚组分析显示，4 至 8 年随访时全因死亡率（HR：1.13；95%CI：0.94-1.35；I=0.0%）和随访时间超过 8 年时全因死亡率（HR：1.07；95%CI：0.89-0.28；I=36.6%）也没有显示两种方法之间有显著差异。在随访期间，与动脉瘤相关的死亡率和动脉瘤破裂的风险相似。然而，在 EVAR 组中，随访期间再次干预的累积风险更高（RR：2.18；95%CI：1.50-3.17；I=76.1%），EVAR 组和手术组分别有 29%和 15%的患者需要再次干预。
EVAR 和开放手术修复 AAA 同样安全，全因死亡率无差异。然而，血管内修复与再次干预的需求增加有关。血管内设备的新技术可能会进一步改善 EVAR 的结果。主题代码：荟萃分析；动脉瘤；动脉粥样硬化；并发症。
