Safety And Effectiveness of Open and Endovascular Repair for Inflammatory Abdominal Aortic Aneurysm: Systematic Review and Meta-Analysis

Abstract

BACKGROUND: Inflammatory abdominal aortic aneurysm (IAAA) is a rare subtype with a pronounced inflammatory response and high complication risk. The optimal treatment remains uncertain. This meta-analysis evaluates mortality and perioperative complications in IAAA patients undergoing endovascular (EVAR) or open surgical repair (OSR). METHODS: A systematic search was conducted in PubMed, SCOPUS, ISI Web of Science, and Cochrane databases. Mortality and complications were analysed using binary common and random-effects models. Study quality was assessed with NHLBI and Risk of Bias 2 tools. RESULTS: Nineteen studies (656 patients) were included. EVAR 30-day mortality was 2.9% (95% CI: 0.4-6.1%; I² = 0%, p = 0.583), while OSR was 9% (95% CI: 5-15%; I² = 58%, p < 0.01). Preoperative hydronephrosis was 12.7% (95% CI: 6.4-19.0%; I² = 0%, p = 0.341) for EVAR and 16.5% (95% CI: 12.9-20.2%; I² = 0%, p = 0.031) for OSR. Postoperative hydronephrosis was 9.8% (95% CI: 1.1-18.6%; I² = 0%, p = 0.444) for EVAR and 6.1% (95% CI: 3.4-8.9%; I² = 0%, p = 0.348) for OSR. CONCLUSION: OSR improves hydronephrosis resolution but has higher mortality and morbidity, while EVAR offers a safer perioperative profile. Individualized strategies are crucial.