Ruptured abdominal aortic aneurysm: open vs. endovascular repair: literature review

Author(s): Amer Harky, Ciaran GraftonClarke, Kai-Wen Chen, Jefferey Shi Kai Chan, Chris Ho Ming Wong, Leith Williams

Ruptured abdominal aortic aneurysm is a surgical emergency, invariably leading to death without urgent intervention. The emergence of endovascular repair has challenged open repair as the treatment of choice and has featured as the focus of numerous observational and randomised trials across the globe. At present, there is no formal consensus upon the gold standard approach in managing patients with ruptured abdominal aortic aneurysms in the emergency environment, despite the formation of protocols and evidence-based guidance within the elective setting. This literature review examines the current evidence underpinning the use of endovascular repair, and evaluates its efficacy compared to open repair. In summary of the literature, there is no conclusive body of evidence to support the claim that endovascular repair is superior to open repair, particularly from a mortality, complication and cost-utility viewpoint. There are significant conflictions within the evidence-base, often between observational studies, but also between the randomised trials, which themselves are limited in number. It would be appropriate to conclude that endovascular repair is as efficacious as open repair but would be invalid in light of the scientific literature to claim it superior.

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