Early and Late Functional Outcome Assessments following Endovascular and Open Aneurysm Repair

Arko, Frank R.; Hill, Bruce C.; Reeves, T R; Olcott, Cornelius; Harris, E. John; Fogarty, Thomas J.; Zarins, Christopher K.

doi:10.1177/152660280301000103

Cited by 32 publications

(15 citation statements)

References 29 publications

(26 reference statements)

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“…In total, 33 clinical studies 2–34 fulfilled the inclusion criteria. One study 34 with modified Evan and Pollock score less than 50 and was excluded.…”

Section: Resultsmentioning

confidence: 99%

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Systematic review of clinical trials comparing open and endovascular treatment of abdominal aortic aneurysm

Yiu

Cheung

et al. 2006

Surgical Practice

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Objective: Endovascular repair (EVAR) using stent-graft device is a new treatment for abdominal aortic aneurysm (AAA) that is gaining more and more popularity. This systematic review compares the new minimally invasive endovascular treatment with the conventional open repair aiming to provide more evidence for clinical decision on choice of treatment for aneurysm patients. Methods: Electronic search on MEDLINE, EMBASE and Cochrane Library and manual search on bibliographies was performed to identify studies published from 1991 to 2004 comparing clinical outcomes of patients who underwent EVAR and open repair. Quality of clinical studies was assessed by modified Evans and Pollok score and those scores below 50 were excluded. Systematic analysis was performed for short-, mid-and longterm clinical outcomes. The effect size of the clinical parameters was estimated by relative risk, weighted mean difference and standard mean difference. Results: 27 clinical studies and 7226 patients were included in this systematic review. Three studies were randomized control studies and the rest were comparative studies. Systematic review showed patients after EVAR had significantly lower 30-day mortality, shorter hospital and intensive care unit stay, less blood loss or blood transfusion, fewer cardiac and respiratory complications, less colonic ischaemia, and fewer overall operative morbidities. But EVAR carried a significant higher frequency of early secondary procedures and graftrelated complications. The 1-5-year mortality between the two groups was similar. Patients receiving EVAR required more late secondary procedures and the cost related to EVAR was higher. Systematic review on quality of life could not be performed as there was a large variation on method of measurement. Conclusions: EVAR offers significant benefit to aneurysm patients in the early postoperative period. However, it does not show an advantage over open repair in mid-and long-term outcome. Furthermore, EVAR might carry more morbidity and higher cost in the long term. Prospective randomized control studies focusing on long-term outcome of EVAR and open repair aneurysm patients as well as on studies on newer generation devices are needed to provide more information for clinical decisions.

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“…In total, 33 clinical studies 2–34 fulfilled the inclusion criteria. One study 34 with modified Evan and Pollock score less than 50 and was excluded.…”

Section: Resultsmentioning

confidence: 99%

“…One study 34 with modified Evan and Pollock score less than 50 and was excluded. Another five studies 29–33 were excluded as they had overlapping of patients from the same institution. One of the studies reported low risk and high risk group patients separately 15 and the data were recorded into two standardized data sheets.…”

Section: Resultsmentioning

confidence: 99%

Systematic review of clinical trials comparing open and endovascular treatment of abdominal aortic aneurysm

Yiu

Cheung

et al. 2006

Surgical Practice

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show abstract

“…Nevertheless, these and other studies (405-407) also have suggested that the total costs of endovascular repair probably exceed those for open repair, especially when the expense of subsequent follow-up imaging, further intervention, and secondary hospital admissions is added to the base cost ($6000 to $12 000 U.S. dollars) of most endografts. Despite the shorter length of stay and earlier return to normal activity associated with aortic endografting, this procedure does not appear to be associated with superior late functional outcome or longer qualityadjusted life expectancy compared with open surgical treatment (408,409).…”

Section: Early Mortality and Complication Ratesmentioning

confidence: 98%

ACC/AHA 2005 Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic): Executive Summary

Wilkins¹

2006

Circulation

131

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“…Still, the deaths in this group have been few, and the overall mortality rate has decreased with the introduction of endovascular techniques. On the other hand, reinterventions after EVAR are more numerous than after open repair, 14 but most of them can be done endoluminally, with less trauma to the patient.…”

Section: Abdominal Aortic Aneurysmsmentioning

confidence: 99%

The Influence of Endovascular Techniques on Our Surgical Practice: A 10-Year View

Brunkwall

Lackner

2004

J Endovasc Ther

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Early and Late Functional Outcome Assessments following Endovascular and Open Aneurysm Repair

Cited by 32 publications

References 29 publications

Systematic review of clinical trials comparing open and endovascular treatment of abdominal aortic aneurysm

Systematic review of clinical trials comparing open and endovascular treatment of abdominal aortic aneurysm

ACC/AHA 2005 Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic): Executive Summary

The Influence of Endovascular Techniques on Our Surgical Practice: A 10-Year View

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