Umbrella review and meta-analysis of reconstructed individual patient data of mortality following conventional endovascular and open surgical repair of infrarenal abdominal aortic aneurysm

ABSTRACT

Objectives

This umbrella review aims to quality assess published meta-analyses, conduct a de-novo meta-analysis of the available randomized control trials (RCTs), and test the hypothesis that there is a long-term difference in mortality between OSR and EVAR.

Methods

A systematic search was conducted in MEDLINE and EMBASE’s bibliographic databases (June 2022). Data were extracted using standardized extraction forms. The methodological quality of publications was assessed using the ROBIS tool. Data were analyzed with ‘one-stage’ and ‘two-stage’ approaches.

Results

According to two-stage analysis, EVAR has significantly favorable mortality for up to four years (increasing evidence). Subsequently, until the longest available time period, there is no difference between EVAR and OSR; all the results are statistically non-significant.

In one stage analysis, the Cox model demonstrated a non-significant (weak evidence) hazard ratio of 1.03 (95% confidence interval [CI]: 0.94–1.12) in favor of OSR. The best-fitting parametric model (generalized gamma), leads to an hazard ratio of 0.97 (95% CI: 0.93–1.01) in favor of EVAR, with the results approaching significance (weak evidence).

Conclusion

The results of this umbrella systematic review and meta-analysis failed to demonstrate any difference in long-term mortality following planned EVAR, compared with OSR of infrarenal AAA.

KEYWORDS:

• Umbrella systematic literature review
• mortality
• IPD meta-analysis
• EVAR
• Abdominal aortic aneurysm

Declaration of interest

VM Veličković has previously received grant funding from ABHI thought Biomath Models. S Neequaye has received fees for consulting services and speaker fees from Terumo Aortic. A Ignjatović previously received grant funding from ABHI thought Biomath Models. D Bogdanović previously received grant funding from ABHI thought Biomath Models.

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

All authors were involved in the conception and design of the study;

DB, AI, and VV executed screening, identifications, and extractions of the data for systematic literature review and meta-analysis;

VV executed analyses and VV, JS, US were involved in the interpretation of the data;

VV produced the first version of the paper, with all authors revising it critically for intellectual content.

All authors approved the final version of manuscript to be published and all authors agree to be accountable for all aspects of the work.

Additional information

Funding

This paper was partly supported by the NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust. The views expressed in this article are those of the authors and do not necessarily represent those of the NHS, the NIHR, or the Department of Health and Social Care.