AB169. SOH25AB_042. Long-term outcomes of endovascular vs. open surgical repair for abdominal aortic aneurysms: a comprehensive meta-analysis
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AB169. SOH25AB_042. Long-term outcomes of endovascular vs. open surgical repair for abdominal aortic aneurysms: a comprehensive meta-analysis

En Qing Lim, Gavin O’Brien

Department of General Surgery, Cork University Hospital, Cork, Ireland

Background: The risk of rupture and mortality associated with abdominal aortic aneurysms (AAA) necessitates timely surgical intervention. Open surgical repair (OSR) and endovascular aneurysm repair (EVAR) are the two primary surgical techniques used and are frequently compared for efficacy and safety. While EVAR is less invasive and associated with lower perioperative mortality, it has a higher risk of long-term complications. This meta-analysis compares long-term outcomes, efficacy, and complication rates between EVAR and OSR to inform clinical decisions and practice.

Methods: Outcomes of EVAR and OSR in AAA were compared through a systematic review and meta-analysis of peer-reviewed studies. The metrics included perioperative mortality, long-term survival, secondary interventions, and complication rates over extended follow-up periods. The analysis adhered to PRISMA guidelines, employing a random-effects model for statistical analysis.

Results: As compared to OSR, EVAR significantly reduced perioperative mortality [odds ratio: 0.45; 95% confidence interval (CI): 0.30–0.68, P<0.01] and facilitated faster recovery. However, over 5–10 years, EVAR patients experienced significantly higher aneurysm-related complications and reinterventions (hazard ratio: 2.85; 95% CI: 1.90–4.12, P<0.001). In contrast, OSR had higher early morbidity but provided more durable outcomes with fewer late complications. Long-term survival rates between the approaches showed no significant difference after risk adjustment.

Conclusions: For high perioperative risk patients, EVAR offers lower short-term mortality and faster recovery. However, OSR is preferable for those fit for major surgery, given its greater long-term durability. Advancements in endovascular technology and monitoring protocols are essential to optimize AAA management. Individualized treatment plans and collaborative decision-making are essential.

Keywords: Abdominal aortic aneurysms (AAA); endovascular aneurysm repair (EVAR); open surgical repair (OSR); perioperative mortality; long-term outcomes

Acknowledgments

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Footnote

Funding: None.

Conflicts of Interest: The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

doi: 10.21037/map-25-ab169
Cite this abstract as: Lim EQ, O’Brien G. AB169. SOH25AB_042. Long-term outcomes of endovascular vs. open surgical repair for abdominal aortic aneurysms: a comprehensive meta-analysis. Mesentery Peritoneum 2025;9:AB169.

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