This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Quality of Care  • Evidence-Based Medicine  • Surgery  • Surgical Interventions  • Cardiovascular/ Cardiothoracic Surgery  • Vascular Surgery  • Surgical Physiology  • Blood/ Coagulation  • Review  • Alert me on articles by topic  Social Bookmarking   What's this?

A Systematic Review and Meta-analysis

Christos D. Karkos, MD, FRCS, PhD; Denis W. Harkin, MD, FRCS, EBSQ-Vasc; Andry Giannakou, MSc; Thomas S. Gerassimidis, MD, PhD

Arch Surg. 2009;144(8):770-778.

Objective  To document mortality after endovascular repair of ruptured abdominal aortic aneurysms (RAAAs).

Data Sources  MEDLINE and EMBASE databases.

Study Selection  Articles that reported data on mortality after endovascular repair of RAAAs were identified. Only patients with true ruptures were included. Additionally, information on mortality after concurrent open repair was sought.

Data Extraction  One of the authors reviewed all of the studies and extracted appropriate data. A total of 43 articles were identified, 14 of which were excluded.

Data Synthesis  Twenty-nine articles with 897 patients who underwent endovascular repair met the inclusion criteria. Of the patients with available information, 86% were men; 29% had been operated on under local anesthesia; 28% were hemodynamically unstable; 17% required intra-aortic balloon occlusion; 48% received bifurcated stent grafts; 6% had endovascular procedures converted to open repair intraoperatively; and 5.5% developed abdominal compartment syndrome. In-hospital and/or 30-day mortality ranged between 0% and 54% in different series, whereas the pooled mortality after endovascular repair was 24.5% (95% confidence interval [CI], 19.8%-29.4%). In 19 studies reporting results of both endovascular and concurrent open repair from the same unit, the pooled mortality after open repair was 44.4% (95% CI, 40.0%-48.8%), and the pooled overall mortality for RAAA undergoing endovascular or open repair was 35% (95% CI, 30%-41%).

Conclusions  Endovascular repair of RAAAs is associated with acceptable mortality rates. Additional studies will be required to verify these promising results and precisely define the role of endovascular treatment as an additional therapeutic option for RAAAs.

Author Affiliations: 5th Department of Surgery, Medical School, Aristotle University of Thessaloniki, Hippocrateio Hospital, Thessaloniki, Greece (Drs Karkos and Gerassimidis); Regional Vascular Surgery Unit, Royal Victoria Hospital, Belfast, Northern Ireland (Dr Harkin); and the Medical Statistics Unit, Department of Mathematics and Statistics, Lancaster University, Lancaster, England (Ms Giannakou).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

Mortality After Endovascular Repair of Ruptured Abdominal Aortic Aneurysms—Invited Critique
James H. Black, III
Arch Surg. 2009;144(8):778-779.
EXTRACT | FULL TEXT