Meta-analysis of fenestrated endovascular aneurysm repair versus open surgical repair of juxtarenal abdominal aortic aneurysms over the last 10 years

Background Juxtarenal abdominal aortic aneurysms pose a significant challenge whether managed endovascularly or by open surgery. Fenestrated endovascular aneurysm repair (FEVAR) is now well established, but few studies have compared it with open surgical repair (OSR). The aim of this systematic review was to compare short- and long-term outcomes of FEVAR and OSR for the management of juxtarenal aortic aneurysms. Methods A literature search was conducted of the Ovid Medline, EMBASE and PubMed databases. Reasons for exclusion were series with fewer than 20 patients, studies published before 2007 and those concerning ruptured aneurysms. Owing to variance in definitions, the terms 'juxta/para/suprarenal' were used; thoracoabdominal aortic aneurysms were excluded. Primary outcomes were 30-day/in-hospital mortality and renal insufficiency. Secondary outcomes included major complication rates, rate of reintervention and rates of endoleak. Results Twenty-seven studies were identified, involving 2974 patients. Study designs included 11 case series, 14 series within retrospective cohort studies, one case-control study and a single prospective non-randomized trial. The pooled early postoperative mortality rate following FEVAR was 3 center dot 3 (95 per cent c.i. 2 center dot 0 to 5 center dot 0) per cent, compared with 4 center dot 2 (2 center dot 9 to 5 center dot 7) per cent after OSR. After FEVAR, the rate of postoperative renal insufficiency was 16 center dot 2 (10 center dot 4 to 23 center dot 0) per cent, compared with 23 center dot 8 (15 center dot 2 to 33 center dot 6) per cent after OSR. The major early complication rate following FEVAR was 23 center dot 1 (16 center dot 8 to 30 center dot 1) per cent versus 43 center dot 5 (34 center dot 4 to 52 center dot 8) per cent after OSR. The rate of late reintervention after FEVAR was higher than that after OSR: 11 center dot 1 (6 center dot 7 to 16 center dot 4) versus 2 center dot 0 (0 center dot 6 to 4 center dot 3) per cent respectively. Conclusion No significant difference was noted in 30-day mortality; however, FEVAR was associated with significantly lower morbidity than OSR. Long-term durability is a concern, with far higher reintervention rates after FEVAR.