Endovascular Treatment Versus Open Surgery for Isolated Iliac Artery Aneurysms: A Systematic Review and Meta-Analysis

Objective: The aim of this review was to compare the outcomes of endovascular treatment (ET) versus open surgery (OS) for patients with isolated iliac artery aneurysms (IIAAs). Methods: Studies that reported ET and OS for IIAAs were searched in databases until December 5, 2018. Studies were included for reporting both ET and OS for patients with IIAAs, and at least one of the following outcomes: postoperative mortality, postoperative ischemic complications (PIC), wound complications, blood transfusion, and length of hospital stay (LHS). We adopted Inverse Variance method to calculate the mean difference (MD) of LHS, and adopted Mantel-Haenszel method for odds ratios (ORs) of postoperative mortality, PICs, wound complications, and blood transfusion. Results: Nine studies were included, and all of them were observational studies, 7 studies were available for meta-analysis. When compared with OS, ET was associated with a higher risk of PICs (OR: 3.24, 95% confidence interval [CI]: 1.05-10.02), a lower risk of blood transfusion (OR: 0.22, 95% CI: 0.08-0.58), and a much shorter LHS (MD: -4.39, 95% CI: -6.18 to -2.60). The postoperative mortality and wound complication were similar between groups. Conclusion: Both ET and OS were safe and effective methods to repair IIAAs with similar postoperative mortality. Compared with OS, ET can reduce the need for transfusion and the time of LHS, but it was associated with a higher risk of PICs. The comparisons of primary patency and reintervention rates were still unclear between the 2 groups.