Comparison of midterm results of FEVAR and open surgery for infrarenal aortic aneurysms with short necks: systematic review with meta-analysis

Abstract

Introduction: This systematic review with meta-analysis aimed to compare short and midterm outcomes between fenestrated endovascular aneurysm repair and open surgery in repair of infrarenal abdominal aortic aneurysms with short necks. Evidence acquisition: PubMed, Web of Science and Scopus electronic databases were searched for studies referring to fenestrated endovascular aneurysm repair or open surgery in patients with infrarenal abdominal aortic aneurysms with neck length <15 mm. The primary endpoint of interest was early mortality. Secondary outcomes included major adverse cardiovascular events, bowel ischemia, acute kidney injury, late mortality and reinterventions. Evidence synthesis: A total of 21 studies were included, with 1157 patients who underwent fenestrated endovascular aneurysm repair and 1927 who underwent open surgery. Meta-analysis demonstrated no significant differences in 30-day mortality (odds ratio=0.79; 95% CI: 0.37, 1.68). A decreased risk of major adverse cardiovascular events and bowel ischemia was present in patients submitted to endovascular repair (respectively, odds ratio=0.51; 95% CI: 0.28, 0.95, and odds ratio=0.30; 95% CI: 0.11, 0.86), although no significant differences were seen for acute kidney injury (odds ratio=0.62; 95% CI: 0.23, 1.67). Late mortality and reintervention risks were both significantly higher in the endovascular group (respectively, odds ratio=1.68; 95% CI: 1.03, 2.74, and odds ratio=4.17; 95% CI: 2.04, 8.50). Conclusions: Endovascular technique demonstrated superior outcomes in perioperative morbidity, at costs of worst midterm performance. Randomized controlled trials are needed to provide secure recommendations towards preferential use of either technique in juxtarenal abdominal aortic aneurysms repair.