Repair of Unruptured Abdominal Aortic Aneurysm
Authors: Hisato Takagi, Norikazu Kawai, Takuya Umemoto
Journal: Annals of Internal Medicine (2008)

Letters5 February 2008Repair of Unruptured Abdominal Aortic AneurysmHisato Takagi, MD, PhD, Norikazu Kawai, MD, and Takuya Umemoto, MD, PhDHisato Takagi, MD, PhDFrom Shizuoka Medical Center, Shizuoka 420 8688, Japan.Search for more papers by this author, Norikazu Kawai, MDFrom Shizuoka Medical Center, Shizuoka 420 8688, Japan.Search for more papers by this author, and Takuya Umemoto, MD, PhDFrom Shizuoka Medical Center, Shizuoka 420 8688, Japan.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-148-3-200802050-00018 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:In a systematic review of repair of unruptured abdominal aortic aneurysm (AAA) by Lederle and colleagues (1), endovascular repair did not reduce all-cause mortality (relative risk, 0.95 [95% CI, 0.76 to 1.19]) but did reduce AAA-related midterm mortality (relative risk, 0.53 [CI, 0.31 to 0.92]) compared with open repair. However, the results of the EVAR (Endovascular Aneurysm Repair) I trial, 1 of the 3 trials included in the systematic review, were recently updated: The number of patients enrolled increased from 1082 to 1252 patients, and the follow-up was extended from median of 2.9 years to mean of 3.8 years (2). Therefore, we performed a meta-analysis of currently available results of randomized, controlled trials of endovascular versus open repair of AAA, including the updated results of the EVAR I trial (2).Our comprehensive search identified 3 randomized trials that have published midterm follow-up results: the DREAM (Dutch Randomized Endovascular Aneurysm Management) trial (3); the EVAR I trial (2); and a trial from Montréal, Québec, Canada (4). Of these 3 individual trials, 2 demonstrated a statistically nonsignificant benefit of endovascular over open repair for AAA-related midterm mortality (relative risk, 0.27 [CI, 0.06 to 1.19] in the DREAM trial and 0.61 [CI, 0.36 to 1.03] in the EVAR I trial), but only the Montréal trial demonstrated a statistically nonsignificant benefit of open over endovascular repair (relative risk, 3.00 [CI, 0.13 to 69.52]). Pooled analysis of the 3 trials demonstrated a statistically nonsignificant reduction in AAA-related midterm mortality with endovascular versus open repair in a random-effects model (relative risk, 0.57 [CI, 0.32 to 1.02]). We found neither between-study heterogeneity of results, analyzed by using standard chi-square tests (P = 0.35), nor evidence of significant publication bias, assessed by using an adjusted rank-correlation test (P = 0.60). Pooled analysis also demonstrated a statistically nonsignificant reduction in all-cause midterm mortality with endovascular versus open repair (relative risk, 0.98 [CI, 0.81 to 1.18]).Despite the results of Lederle and colleagues' systematic review (1), our meta-analysis of all currently available results of randomized, controlled trials failed to demonstrate significant benefit of endovascular over open repair for not only all-cause but also AAA-related midterm mortality.Hisato Takagi, MD, PhDNorikazu Kawai, MDTakuya Umemoto, MD, PhDShizuoka Medical CenterShizuoka 420 8688, JapanReferences1. Lederle FA, Kane RL, MacDonald R, Wilt TJ. Systematic review: repair of unruptured abdominal aortic aneurysm. Ann Intern Med. 2007;146:735-41. [PMID: 17502634] LinkGoogle Scholar2. Brown LC, Greenhalgh RM, Howell S, Powell JT, Thompson SG. Patient fitness and survival after abdominal aortic aneurysm repair in patients from the UK EVAR trials. Br J Surg. 2007;94:709-16. [PMID: 17514695] CrossrefMedlineGoogle Scholar3. Blankensteijn JD, de Jong SE, Prinssen M, van der Ham AC, Buth J, van Sterkenburg SM, et al; Dutch Randomized Endovascular Aneurysm Management (DREAM) Trial Group. Two-year outcomes after conventional or endovascular repair of abdominal aortic aneurysms. N Engl J Med. 2005;352:2398-405. [PMID: 15944424] CrossrefMedlineGoogle Scholar4. Soulez G, Thérasse E, Monfared AA, Blair JF, Choiniére M, Elkouri S, et al. Pain and quality of life assessment after endovascular versus open repair of abdominal aortic aneurysms in patients at low risk. J Vasc Interv Radiol. 2005;16:1093-100. [PMID: 16105921] CrossrefMedlineGoogle Scholar Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: From Shizuoka Medical Center, Shizuoka 420 8688, Japan.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoSystematic Review: Repair of Unruptured Abdominal Aortic Aneurysm Frank A. Lederle , Robert L. Kane , Roderick MacDonald , and Timothy J. Wilt Metrics 5 February 2008Volume 148, Issue 3Page: 245-246KeywordsAneurysmsConflicts of interestSystematic reviews ePublished: 5 February 2008 Issue Published: 5 February 2008 CopyrightCopyright © 2008 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...