Title: A comparison of endovascular aneurysm repair and open repair for ruptured aortic abdominal aneurysms

Abstract

Background: Management modalities of ruptured Abdominal aortic aneurism (AAA) include ruptured open aneurysm repair (rOAR) and ruptured endovascular aneurysm repair (rEVAR). In this study, we aim to systematically review all the previously published randomized controlled trials (RCTs) that compared rOAR and rEVAR.. Methods: A systematic search was performed in the following databases: PubMed, Scopus, Web of Science, Google Scholar, Clinical trials, and others with all the potentially relevant keywords that were adjusted to meet the search strategy for each database to collect all the relevant studies that were published up to January 2021. Results: A total of 11 studies were identified through our comprehensive search. Among these studies, seven represented the IMPROVE trial, two represented the AJAX trial, two represented the Nottingham and ECAR trials, each, while the remaining four studies were not RCTs, however, these were included in the discussion as they obtained data from the IMPROVE trial. The IMPROVE trials preferred EVAR use due to the potential survival benefit and improved quality of life, although the EVAR and OAR had similar mortality rates. In the AJAX and ECAR, the mortality rates favored EVAR over OAR with no significance while the opposite was noticed in the Nottingham trial with no significance also. Similar rates of re- interventions and complications were also noticed and some studies reported that EVAR is cost-effective. Conclusion: No consensus has been found to favour one of the modalities over the other. However, trials seem to favour EVAR on a short-term basis, while OAR is superior regarding the long-term outcomes.