Midterm results after FEVAR and open surgery for infrarenal aortic aneurysms with short proximal necks: systematic review with meta-analysis of comparative studies.

INTRODUCTION

This systematic review with meta-analysis aimed to compare short and midterm outcomes between fenestrated endovascular aneurysm repair and open surgery in repair of infrarenal abdominal aortic aneurysms with short necks.

EVIDENCE ACQUISITION

PubMed, Web of Science and Scopus electronic databases were searched for studies referring to fenestrated endovascular aneurysm repair (FEVAR) or open surgery (OSR) in patients with infrarenal abdominal aortic aneurysms with neck length <15 mm. The primary endpoint of interest was early mortality. Secondary outcomes included major adverse cardiovascular events (MACE), bowel ischemia, acute kidney injury (AKI), late mortality and secondary interventions.

EVIDENCE SYNTHESIS

Overall, 21 studies were included, with a total of 3084 patients (1157 FEVAR and 1927 OSR). The pooled rate of early mortality following FEVAR was 2.7% (95%CI: 1.6, 4.0; I=27.7%), compared with 3.7% (95%CI: 1.9, 6.0; I=78.1%) after OSR. Comparative studies demonstrated no significant differences in 30-day mortality (odds ratio [OR] 0.79; 95%CI: 0.37, 1.68). A decreased risk of postoperative MACE (OR=0.51; 95%CI: 0.28, 0.95) and bowel ischemia (OR=0.30; 95%CI: 0.11, 0.86) was observed in FEVAR patients although no significant differences were seen regarding AKI (OR=0.62; 95%CI: 0.23, 1.67). Late mortality (OR=1.68; 95%CI: 1.03, 2.74) and reintervention risk (OR=4.17; 95%CI: 2.05, 8.50) were both significantly higher in FEVAR group.

CONCLUSIONS

FEVAR and OSR showed no statistically significant differences in postoperative mortality in the treatment of patients with AAA with short neck length, despite lower morbidity in the former. Oppositely, FEVAR present with greater mortality and reintervention risk in the midterm. Randomized controlled trials are needed to provide secure recommendations towards preferential use of either technique for juxtarenal AAA repair.