alexa A meta-analysis and metaregression analysis of factors influencing mortality after endovascular repair of ruptured abdominal aortic aneurysms


Angiology: Open Access

Author(s): Karkos CD

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OBJECTIVE: To determine factors that may influence the perioperative mortality after endovascular repair of ruptured abdominal aortic aneurysms (RAAAs) using metaregression analysis. METHODS: A meta-analysis of all English-language literature with information on mortality rates after endovascular repair of RAAAs was conducted. A metaregression was subsequently performed to determine the impact on mortality of the following 8 factors: patient age; mid-time study point; anaesthesia; endograft configuration; haemodynamic instability; use of aortic balloon; conversion to open repair; and abdominal compartment syndrome. RESULTS: The pooled perioperative mortality across the 46 studies (1397 patients) was 24.3% (95% CI: 20.7-28.3%). Of the 8 variables, only bifurcated approach was significantly associated with reduced mortality (p = 0.005). A moderate negative correlation was observed between bifurcated approach and haemodynamic instability (-0.35). There was still a strong association between bifurcated approach and mortality after simultaneously adjusting for haemodynamic instability, indicating that the latter was not a major factor in explaining the observed association. CONCLUSIONS: Endovascular repair of RAAAs is associated with acceptable mortality rates. Patients having a bifurcated endograft were less likely to die. This may be due to some surgeons opting for a bifurcated approach in patients with better haemodynamic condition. Further studies will be needed to clarify this.

This article was published in Eur J Vasc Endovasc Surg and referenced in Angiology: Open Access

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