Endovascular vs Open Aneurysm Repair in the Young: Systematic Review and Meta-analysis

Purpose: To examine the results of elective abdominal aortic aneurysm (AAA) repair in young patients (<70 years old) and compare the outcome of endovascular aneurysm repair (EVAR) and open surgical repair (OSR) techniques. Methods: The MEDLINE, CENTRAL, and OpenGray databases were searched from January 2000 to March 2015. Periprocedural (30-day mortality and morbidity, length of hospitalization) and long-term outcomes (long-term mortality, rate of secondary procedures) were compared between young patients undergoing EVAR and OSR. For the meta-analysis of comparative studies, the random effects model was used to calculate combined overall effect sizes of pooled data. One randomized control trial and 8 observational studies were included in the analysis. Data are presented as the odds ratio (OR) or mean difference (MD) with 95% confidence interval (CI). Results: EVAR was associated with a decreased risk of 30-day mortality (OR 0.25, 95% CI 0.14 to 0.42, p<0.001) and 30-day morbidity (OR 0.36, 95% CI 0.22 to 0.58, p<0.001) and shorter length of hospitalization (MD -4.28 days, 95% CI -4.86 to -3.70, p<0.001). Moreover, a potential long-term survival benefit did not reach statistical significance (OR 0.48, 95% CI 0.17 to 1.34, p=0.16), whereas the need for reintervention was similar between EVAR and OSR groups (OR 0.94, 95% CI 0.61 to 1.54, p=0.89). Conclusion: There are insufficient data for definite conclusions to be drawn regarding the relative effectiveness of EVAR and OSR in young subjects. Contemporary evidence suggests that EVAR should not be discouraged in this cohort of patients based solely on the age criterion.