Abdominal aortic aneurysm (AAA) has shown to be a significant health disorder globally, with its prevalence steadily rising, particularly in the aging population. The choice between endovascular aneurysm repair (EVAR) and open surgical repair (OSR) has become a focal point of discussion and clinical decision-making. This systematic review aimed to comprehensively evaluate and compare the outcomes of endovascular and surgical treatments for AAA. The search strategy employed a combination of relevant keywords related to “EVAR, OSR, AAA, and relevant outcomes such as all-cause mortality and reintervention”. Meta-analysis was conducted using appropriate statistical methods to pool data from individual studies and estimate overall effect sizes. This systematic review and meta-analysis included 34 articles. The findings indicated that patients undergoing EVAR had a significantly higher long-term all-cause mortality rate of 27.8%, compared to 24.6% in the OSR group. In terms of very long-term (10-year) all-cause mortality, data from 12 studies comprising 46,932 patients (32,523 EVAR and 14,409 OSR) showed no significant difference between the two groups. Additionally, the analysis revealed that EVAR patients experienced a higher very long-term reintervention rate of 21.8%, compared to 10.4% in the OSR group. The results suggested that EVAR is linked to higher rates of long-term all-cause mortality, reintervention, and secondary rupture as compared to OSR. Even over the very long term, EVAR showed persistently higher rates of reintervention and secondary rupture.
Key words: Endovascular, surgical, treatments, abdominal aortic aneurysms, systemic review
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