This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Systematic review of recent evidence for the safety and efficacy of elective endovascular repair in the management of infrarenal abdominal aortic aneurysm. BJS 2005; 92: 937-946.
Published: 20th July 2005
Authors: D. Drury, J. A. Michaels, L. Jones, L. Ayiku
Background
Conventional management of abdominal aortic aneurysm (AAA) is by open repair and is associated with a mortality rate of 2–6 per cent. Endovascular aneurysm repair (EVAR) is an alternative technique first introduced in 1991. A systematic review was undertaken of the evidence for the safety and efficacy of elective EVAR in the management of asymptomatic infrarenal AAA.
Method
Thirteen electronic bibliographical databases were searched, covering biomedical, health‐related, science and social science literature. Outcomes were assessed with respect to efficacy (successful deployment, technical success, conversion rates and secondary intervention rates) and safety (30‐day mortality rate, procedure morbidity rates and technical issues—endoleaks, graft thrombosis, stenosis and migration).
Results
Of 606 reports identified, 61 met the inclusion criteria (three randomized and 15 non‐randomized controlled trials, and 43 uncontrolled studies). There were 29 059 participants in total; 19 804 underwent EVAR. Deployment was successful in 97·6 per cent of cases. Technical success (complete aneurysm exclusion) was 81·9 per cent at discharge and 88·8 per cent at 30 days. Secondary intervention to treat endoleak or maintain graft patency was required in 16·2 per cent of patients. Mean stay in the intensive care unit and mean hospital stay were significantly shorter following EVAR. The 30‐day mortality rate for EVAR was 1·6 per cent (randomized controlled trials) and 2·0 per cent in nonrandomized trials and case series. Technical complications comprised stent migration (4·0 per cent), graft limb thrombosis (3·9 per cent), endoleak (type I, 6·8 per cent; type II, 10·3 per cent; type III, 4·2 per cent) and access artery injury (4·8 per cent).