A best evidence topic in vascular surgery was constructed according to a structured protocol. The question addressed was whether @entity1 with @entity1755 ( @entity1028 ) treated with @entity439 repair (EVAR) have improved in-hospital outcomes compared with conventional surgical repair. The reported search retrieved 1398 reports, of which 6 papers were thought to represent the best available evidence to answer the study question. Three randomized trials were identified. The first was a pilot trial conducted in a single centre in the UK, which recruited 32 @entity1 and found similar 30-day mortality in the @entity1 groups. The second trial, conducted in Netherlands, recruited 116 @entity1 anatomically suitable for EVAR. This trial found no significant difference in the composite of @entity204 and severe complications within 30 days of intervention between @entity1 subjected to EVAR and those undergoing open repair (42 vs 47%; absolute risk reduction 5.4%, 95% confidence interval: -13% to +23%). The IMPROVE trial, based on a pragmatic design, demonstrated similar 30-day mortality in the 613 @entity1 randomized to endovascular strategy or open repair (35.4 vs 37.4%, P = 0.62). The average hospital costs within the first 30 days of randomization were similar between the randomized groups, with an incremental cost-saving for the endovascular strategy vs open repair of   1186. Meta-analysis of all three randomized trials in a Cochrane review found no difference in 30-day or in-hospital mortality between EVAR and open repair (odds ratio: 0.91, 95% confidence interval: 0.67-1.22; P = 0.52). In contrast, a systematic review and meta-analysis, mainly of observational, cohort studies, and another large, nationwide study demonstrated EVAR to be associated with improved in-hospital results compared with open repair, as expressed by mortality, severe complications, length of hospital stay and proportion of @entity1 discharged home. Even though randomized trials demonstrate equivalent in-hospital mortality with EVAR and open repair, large-scale, nationwide, observational studies and meta-analyses have shown EVAR to confer improved in-hospital mortality and morbidity in @entity1 with favourable @entity439 morphology stable enough to undergo imaging. Reconfiguration of acute aortic services and establishment of standardized institutional protocols might be advisable for improvements in the management of @entity1755 .

Is endovascular repair of XXXX associated with improved in-hospital mortality compared with surgical repair?

@entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity1755 :: ('MESH:D001019', 'Disease') :: ['ruptured AAA', 'ruptured abdominal aortic aneurysm'] @entity439 :: ('MESH:D000783', 'Disease') :: ['endovascular aneurysm', 'aneurysm'] @entity204 :: ('MESH:D003643', 'Disease') :: ['death'] @entity1028 :: ('MESH:D017544', 'Disease') :: ['AAA']
@entity1755 :: (MESH:D001019,Disease) :: ['ruptured abdominal aortic aneurysms']
