Late Rupture of Abdominal Aortic Aneurysm After Previous Endovascular Repair: A Systematic Review and Meta-analysis

J Endovasc Ther. 2015 Oct;22(5):734-44. doi: 10.1177/1526602815601405. Epub 2015 Aug 18.

Abstract

Purpose: To report a systematic literature review of late rupture of abdominal aortic aneurysm (AAA) after endovascular aneurysm repair (EVAR) and the results of a pooled analysis of causes, treatment, and outcomes.

Methods: Electronic information sources and bibliographic reference lists were interrogated using a combination of free text and controlled vocabulary searches; 11 articles were ultimately identified that fulfilled the inclusion criteria. The articles reported a total of 190 patients who were included in the qualitative and quantitative synthesis. Mortality within 30 days or during the admission with aneurysm rupture was a primary endpoint; major perioperative morbidity was a secondary endpoint. A meta-analysis was performed for 30-day/in-hospital mortality using the random effects model.

Results: A total of 152 ruptures occurred after 16,974 EVAR procedures reported by 8 of the case series, giving an incidence of 0.9% [95% confidence interval (CI) 0.77 to 1.05]. The mean time to rupture was 37 months. Twenty-nine percent (95% CI 20 to 39) of the patients had at least one previous secondary endovascular intervention following the initial EVAR, and 37% (95% CI 30 to 45) were not compliant with surveillance. Type I and III endoleaks were the predominant causes of rupture. Open surgical treatment was undertaken in 61% (95% CI 53 to 68) of the patients who underwent treatment. The pooled estimate for perioperative mortality was 32% (95% CI 24 to 41). A significantly lower mortality was found with endovascular treatment than open surgical management (p=0.027).

Conclusion: 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; a large proportion of late ruptures are amenable to endovascular treatment.

Keywords: abdominal aortic aneurysm; aneurysm rupture; complications; conversion; endoleak; endovascular aneurysm repair; meta-analysis; mortality; open repair; secondary interventions; stent-graft; surveillance.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Aortic Aneurysm, Abdominal / diagnosis
  • Aortic Aneurysm, Abdominal / mortality
  • Aortic Aneurysm, Abdominal / surgery*
  • Aortic Rupture / diagnosis
  • Aortic Rupture / etiology*
  • Aortic Rupture / mortality
  • Aortic Rupture / therapy
  • Blood Vessel Prosthesis Implantation / adverse effects*
  • Blood Vessel Prosthesis Implantation / mortality
  • Endoleak / diagnosis
  • Endoleak / etiology*
  • Endoleak / mortality
  • Endoleak / therapy
  • Endovascular Procedures / adverse effects*
  • Endovascular Procedures / mortality
  • Hospital Mortality
  • Humans
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Treatment Outcome