A Meta analysis on endovascular vs open repair for abdominal aortic aneurysm in patients aged 80 and older

Objective To investigate the therapeutic effect between endovascular repair (EVAR) and open surgical repair (OSR) of AAA in patients aged ≥80 years. Methods We searched MEDLINE (1991.1-2014.7), Ovid (1991.1-2014.7), CBM (1998.1-2014.7) and CNKI (1998.1-2014.7) database. Meta-analyses was performed through software STATA 12.0. Results Eight observational studies reporting on 13 490 octogenarian AAAs were included in this analysis. 6 763 AAA patients underwent EVAR and 6 727 AAAs underwent OSR. Although EVAR did not reduce cerebrovascular complication (OR=0.156, P=0.172), EVAR was associated with a significantly lower risk of postoperative cardiac complications (OR=0.092, P=0.008), pulmonary complications (OR=0.059, P=0.011) and renal complications (OR=0.097, P=0.007). Pooled analysis showed lower 30-day mortality after EVAR compared with OSR (OR=0.240, 95%CI: 0.197-0.293, P<0.001). As for medium-long term results, four studies found similar overall survival at 3 years after EVAR and open repair (OR=1.14, P=0.208). Sensitivity analysis including four studies (recruiting AAAs more than 100 cases in each study) found similar 30-day mortality. Conclusions EVAR in aged 80 and older AAAs is associated with significantly lower 30-day mortality and morbidity than OSR. Key words: Aortic aneurysm, abdominal; Meta-analysis; Aged, 80 and older; Mortality