Endovascular repair of abdominal aortic aneurysm.

@article{Paravastu2014EndovascularRO,
  title={Endovascular repair of abdominal aortic aneurysm.},
  author={Sharath C. V. Paravastu and Rubaraj Jayarajasingam and Rachel Cottam and Simon J Palfreyman and Jonathan Anthony Michaels and Steven Mulackal Thomas},
  journal={The Cochrane database of systematic reviews},
  year={2014},
  volume={1},
  pages={
          CD004178
        }
}
BACKGROUND An abnormal dilatation of the abdominal aorta is referred to as an abdominal aortic aneurysm (AAA). Due to the risk of rupture, surgical repair is offered electively to individuals with aneurysms greater than 5.5 cm in size. Traditionally, conventional open surgical repair (OSR) was considered the first choice approach. However, over the past two decades endovascular aneurysm repair (EVAR) has gained popularity as a treatment option. This article intends to review the role of EVAR in… 
Endovascular treatment for ruptured abdominal aortic aneurysm.
TLDR
The advantages and disadvantages of emergency endovascular aneurysm repair (eEVAR) in comparison with conventional open surgical repair for the treatment of ruptured abdominal aortic aneurYSm (RAAA) are assessed.
Endovascular treatment for ruptured abdominal aortic aneurysm.
TLDR
It is unclear if eEVAR will lead to significant improvements in outcomes for patients or if indeed it can replace conventional open repair as the preferred treatment for this lethal condition, and the quality of the evidence for myocardial infarction, renal complications, and respiratory failure was downgraded.
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TLDR
Evaluating the currently reported mortality evidence after EVAR demonstrates that newer studies show better long-term outcomes than the older ones, proposing a possible improvement of EVAR techniques and perioperative care and providing encouraging evidence for a wider application of EVsAR.
Cost-Effectiveness of Endovascular Versus Open Repair of Abdominal Aortic Aneurysm: A Systematic Review
TLDR
The EVAR technique has been more cost-effective than OSR for high-risk patients, but the need for continuous follow-up, increased costs, and re-intervention over the long term and for low- risk patients has reduced the cost-effectiveness of this method.
Open abdominal aortic aneurysm repair is still necessary in an era of advanced endovascular repair.
TLDR
Evidence to support the strict adherence to IFU protocols of the fenestrated endovascular aneurysm repair (FEVAR) device in patients is found, and the institution's practice has been to continue to perform open abdominal aortic aneurYSm repair for patients with anatomy outside device protocols.
Current treatment strategies for ruptured abdominal aortic aneurysm
TLDR
This review discusses the current treatment strategies in rAAA repair including diagnostics, peri-operative management and results of OR and EVAR, focussing on RCTs comparing both modalities.
Late Rupture of Abdominal Aortic Aneurysm After Previous Endovascular Repair
TLDR
Graft-related endoleaks appear to be the predominant causes of late aneurysm rupture; quality of and compliance with post-EVAR surveillance are important factors in late rupture.
Laparoscopic surgery for elective abdominal aortic aneurysm repair.
TLDR
Current evidence suggests that elective laparoscopic AAA repair has a favourable safety profile comparable with that of EVAR, with low conversion rates as well as similar mortality and morbidity rates.
Patients with familial abdominal aortic aneurysms are at increased risk for endoleak and secondary intervention following elective endovascular aneurysm repair.
TLDR
Patients with fAAA do not have increased perioperative morbidity following open or endovascular AAA repair, however, patients with f AAA do have an increased risk of endoleak and secondary intervention following EVAR, suggesting that EVAR and open AAA repair are both safe and effective for fAAA patients.
Retrograde type B aortic dissection as a complication of standard endovascular aortic repair.
TLDR
In these cases, the only possible strategy may be to carefully study the entire aorta before an EVAR procedure, eventually switching the indication to an open surgical repair or carrying out a more aggressive management, treating the defects of the thoracic aortsa.
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References

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TLDR
Endovascular repair was associated with increased rates of graft-related complications and reinterventions and was more costly than open surgical repair, but no differences were seen in total mortality or aneurysm-related mortality in the long term.
The PIVOTAL study: a randomized comparison of endovascular repair versus surveillance in patients with smaller abdominal aortic aneurysms.
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TLDR
A clinical trial testing the hypothesis that EVAR is beneficial in patients with small AAA, and the results of PIVOTAL should provide objective evidence to guide the use of EVAR for small AAAs.
The ACE trial: a randomized comparison of open versus endovascular repair in good risk patients with abdominal aortic aneurysm.
TLDR
The ACE (Anevrysme de l'aorte abdominale, Chirurgie versus Endoprothese) trial is a multicenter, prospective randomized trial aimed at assessing the results of EVAR and of open surgery in relatively good-risk patients presenting with an asymptomatic abdominal aortic or aortoiliac aneurysm.
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TLDR
The purpose of this study is to establish which technique is more suitable for the treatment of the AAA in the elderly patients.
Long-term comparison of endovascular and open repair of abdominal aortic aneurysm.
TLDR
Endovascular repair led to increased long-term survival among younger patients but not among older patients, for whom a greater benefit from the endovascular approach had been expected, but rupture after repair remained a concern.
Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial
TLDR
In patients with large AAAs, treatment by EVAR reduced the 30-day operative mortality by two-thirds compared with open repair, and any change in clinical practice should await durability and longer term results.
A randomized controlled trial of endovascular aneurysm repair versus open surgery for abdominal aortic aneurysms in low- to moderate-risk patients.
TLDR
In patients with low to intermediate risk factors, open repair of AAA is as safe as EVAR and remains a more durable option.
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TLDR
EVAR did not improve survival over no intervention and was associated with a need for continued surveillance and reinterventions, at substantially increased cost.
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TLDR
The CAESAR Trial aims to assess the outcome of endovascular repair (EVAR) vs surveillance of small abdominal aortic aneurysms (AAA) with maximum diameter of 4.1-5.4 cm, and to show that early EVAR is associated with a 15% survival benefit at 54 months.
A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms.
TLDR
Endovascular repair is preferable to open repair in patients who have an abdominal aortic aneurysm that is at least 5 cm in diameter and long-term follow-up is needed to determine whether this advantage is sustained.
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