A Meta-analysis and Metaregression Analysis of Factors Influencing Mortality after Endovascular Repair of Ruptured Abdominal Aortic Aneurysms

作者：Karkos C D^*; Sutton A J; Bown M J; Sayers R D

来源：European Journal of Vascular and Endovascular Surgery, 2011, 42(6): 775-786.

DOI：10.1016/j.ejvs.2011.07.028

• Endovascular repair
• Ruptured abdominal aortic aneurysms
• Mortality
• Prognostic risk factors
• Meta-analysis
• Metaregression

Objective: To determine factors that may influence the perioperative mortality after endovascular repair of ruptured abdominal aortic aneurysms (RAAAs) using metaregression analysis.
Methods: A meta-analysis of all English-language literature with information on mortality rates after endovascular repair of RAAAs was conducted. A metaregression was subsequently performed to determine the impact on mortality of the following 8 factors: patient age; mid-time study point; anaesthesia; endograft configuration; haemodynamic instability; use of aortic balloon; conversion to open repair; and abdominal compartment syndrome.
Results: The pooled perioperative mortality across the 46 studies (1397 patients) was 24.3% (95% CI: 20.7-28.3%). Of the 8 variables, only bifurcated approach was significantly associated with reduced mortality (p = 0.005). A moderate negative correlation was observed between bifurcated approach and haemodynamic instability (-0.35). There was still a strong association between bifurcated approach and mortality after simultaneously adjusting for haemodynamic instability, indicating that the latter was not a major factor in explaining the observed association.
Conclusions: Endovascular repair of RAAAs is associated with acceptable mortality rates. Patients having a bifurcated endograft were less likely to die. This may be due to some surgeons opting for a bifurcated approach in patients with better haemodynannic condition. Further studies will be needed to clarify this.

• 出版日期2011-12