Ruptured Aneurysm Trials: The Importance of Longer-term Outcomes and Meta-analysis for 1-year Mortality

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Health Economics

Background:

• Ruptured abdominal aortic aneurysm (AAA) remains a high-mortality condition.
• Optimal management strategies, particularly endovascular versus open repair, require ongoing evaluation.

Purpose of the Study:

• To evaluate the 1-year outcomes of endovascular aneurysm repair (EVAR) versus open repair for ruptured AAA.
• To synthesize data from three recent randomized controlled trials.

Main Methods:

• Individual patient data meta-analysis of 817 patients from 3 randomized trials.
• Comparison of all-cause mortality and re-intervention rates at 1 year post-procedure.
• Analysis of pooled odds ratios to determine treatment efficacy.

Main Results:

• 1-year mortality was 38.6% for EVAR and 42.8% for open repair (pooled OR 0.84, p=.209).
• No significant heterogeneity in outcomes between trials was observed.
• Restricting analysis to anatomically suitable ruptured AAA patients in one trial showed a trend towards lower mortality with EVAR (OR 0.80).

Conclusions:

• A consistent, though non-significant, trend favors lower 1-year mortality with EVAR for ruptured AAA.
• Combined with positive health economic data, these findings support increased use of endovascular repair for ruptured aneurysms.