Visceral Aneurysms: Systematic Review and Meta-analysis of Endovascular Versus Open Repair

The aim of this study was to analyse and compare the outcome of open surgery (OS) and endovascular repair (ER) for the treatment of visceral artery aneurysms (VAA). A systematic literature search was carried out. 25 comparative cohort studies with 4447 patients (2469 OS and 1978 ER) were included in the meta-analysis. Mortality (ER vs OS 1.8% vs 2.1%, OR .77, 95% CI [.51; 1.17], P = .23) and technical success rates (97% vs 98%, OR .50, 95% CI [.21; 1.16], P = .11) were comparable between both groups. Lower mortality rates for ER were observed for ruptured aneurysms (4.1% vs 31%, OR .43 95% CI [.13; 1.43], P = .17). Length of stay was shorter (mean difference -4.25 days, 95% CI [-5.52; -2.98], P < .00001) and 1-year reintervention rates were higher in the ER group (9% vs 5%, OR 1.55 95% CI [.58; 4.12], P = .38. The presented evidence suggests that ER should be considered a first-line treatment for VAAs, especially in an emergency setting, due to lower morbidity and comparable mortality and technical success. Follow-up should be offered to these patients due to the higher reintervention rates. Systematic review registration PROSPERO ID 348699