A comparative study on the medium-long term results of endovascular repair and open surgical repair in the management of ruptured abdominal aortic aneurysms

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	A comparative study on the medium-long term results of endovascular repair and open surgical repair in the management of ruptured abdominal aortic aneurysms
其他题名	A comparative study on the medium-long term results of endovascular repair and open surgical repair in the management of ruptured abdominal aortic aneurysms
	Han Yanshuo; Zhang Jian; Xia Qian; Liu Zhimin; Zhang Xiaoyu; Wu Xiaoyu; Lun Yu; Xin Shijie; Duan Zhiquan; Xu Ke
	2013
发表期刊	CHINESE MEDICAL JOURNAL
ISSN	0366-6999
卷号	126 期号:24 页码:4771-4779
摘要	Background Although it is generally acknowledged that patients with ruptured abdominal aortic aneurysm (rAAA) obtain the greatest benefit from endovascular repair (EVAR), convincing evidence on the medium-long term effect is lacking. The aim of this study was to compare and summarize published results of rAAA that underwent EVAR with open surgical repair (OSR).
其他摘要	Background Although it is generally acknowledged that patients with ruptured abdominal aortic aneurysm (rAAA) obtain the greatest benefit from endovascular repair (EVAR), convincing evidence on the medium-long term effect is lacking. The aim of this study was to compare and summarize published results of rAAA that underwent EVAR with open surgical repair (OSR). Methods A search of publicly published literature was performed. Based on an inclusion and exclusion criteria, a systematic meta-analysis was undertaken to compare patient characteristics, complications, short term mortality and medium-long term outcomes. A random-effects model was used to pool the data and calculate pooled odds ratios and weighted mean differences. A quantitative method was used to analyze the differences between these two methods. Results A search of the published literature showed that fourteen English language papers comprising totally 1213 patients with rAAA (435 EVAR and 778 OSR) would be suitable for this study. Furthermore, 13 Chinese studies were included, including 267 patients with rAAA totally, among which 238 patients received operation. The endovascular method was associated with more respiratory diseases before treatment (OR=1.81, P=0.01), while there are more patients with hemodynamic instability before treatment in OSR group (OR=1.53, P=0.031). Mean blood transfusion was 1328 ml for EVAR and 2809 ml for OSR (weighted mean difference (WMD) 1500 ml, P=0.014). The endovascular method was associated with a shorter stay in intensive care (WMD 2.34 days, P <0.001) and a shorter total post-operative stay (WMD 6.27 days, P <0.001). The pooled post-operative complication rate of respiratory system and visceral ischemia seldom occurred in the EVAR group (OR=0.48, P <0.001 and OR=0.28, P=0.043, respectively). The pooled 30-day mortality was 25.7% for EVAR and 39.6% for OSR, and the odds ratio was 0.53 (95% confidence interval (CI) 0.41?0.70, P <0.001). There was not, however, any significant reduction in the medium-long all-cause mortality rate (HR=1.13, P=0.381) and re-intervention rate (OR= 2.19, P=0.243) following EVAR. In EVAR group, nevertheless, incidence of type I endoleak was significantly lower than type II endoleak (OR=0.33, P=0.039) at late follow-up period. Conclusions On the basis of this systematic review, rAAA EVAR results in less blood use for transfusion, shorter operation time, shorter intensive care unit and hospital stays, and lower 30-day mortality. However, in the medium-long term, it is not associated with a reduction in all-cause mortality.
关键词	OPEN SURGERY METAANALYSIS OUTCOMES FEASIBILITY EXPERIENCE MORTALITY SURVIVAL TRIALS IMPACT
收录类别	CSCD
语种	英语
资助项目	[National Natural Science Foundation of China] ; [Department of Education of Liaoning Province (Key Laboratory Project)] ; [Ministry of Education of China (Key Research Project of Science and Technology]
CSCD记录号	CSCD:5008028
引用统计	被引频次：1[CSCD] [CSCD记录]
文献类型	期刊论文
条目标识符	http://ir.imr.ac.cn/handle/321006/153544
专题	中国科学院金属研究所
作者单位	中国科学院金属研究所
推荐引用方式 GB/T 7714	Han Yanshuo,Zhang Jian,Xia Qian,et al. A comparative study on the medium-long term results of endovascular repair and open surgical repair in the management of ruptured abdominal aortic aneurysms[J]. CHINESE MEDICAL JOURNAL,2013,126(24):4771-4779.
APA	Han Yanshuo.,Zhang Jian.,Xia Qian.,Liu Zhimin.,Zhang Xiaoyu.,...&Xu Ke.(2013).A comparative study on the medium-long term results of endovascular repair and open surgical repair in the management of ruptured abdominal aortic aneurysms.CHINESE MEDICAL JOURNAL,126(24),4771-4779.
MLA	Han Yanshuo,et al."A comparative study on the medium-long term results of endovascular repair and open surgical repair in the management of ruptured abdominal aortic aneurysms".CHINESE MEDICAL JOURNAL 126.24(2013):4771-4779.