Editor's Choice - Endovascular Aneurysm Repair in High Risk Patients: A Systematic Review and Meta-Analysis

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Public Health

Background:

• Endovascular Aneurysm Repair (EVAR) is an alternative to open surgery for abdominal aortic aneurysms.
• High-risk patients present unique challenges and outcomes in EVAR.
• Assessing EVAR effectiveness in this population is crucial for clinical decision-making.

Purpose of the Study:

• To evaluate the outcomes of EVAR specifically in high-risk patient populations.
• To analyze trends in peri-operative mortality for EVAR in high-risk individuals.
• To compare EVAR outcomes against open repair and no intervention in high-risk patients.

Main Methods:

• Comprehensive literature search across major databases (MEDLINE, EMBASE, CINAHL, CENTRAL).
• Meta-analysis of pooled estimates using odds ratios and hazard ratios with 95% confidence intervals.
• Meta-regression to assess temporal trends in peri-operative mortality; GRADE framework for evidence certainty.

Main Results:

• Pooled peri-operative mortality for EVAR in 18,416 high-risk patients was 3% and has significantly decreased over time.
• EVAR showed lower peri-operative mortality than open repair but no significant difference in overall or aneurysm-related mortality.
• EVAR significantly reduced aneurysm-related mortality compared to no intervention, but no overall survival benefit was observed.

Conclusions:

• Peri-operative mortality for EVAR in high-risk patients has improved.
• EVAR offers a survival benefit in reducing aneurysm-related mortality versus no intervention.
• The overall survival benefit of EVAR in high-risk patients remains uncertain, necessitating further investigation.