Authors' objectives:

To summarise the available evidence on the effectiveness of endovascularly placed grafts for the repair of aortic and carotid artery disease. The report is confined to infrarenal abdominal aortic aneurysms (AAAs).

Authors' results and conclusions: Immediate post-operative technical success ranged from 48-95%, but improved to 60-97% with additional endovascular interventions or spontaneous sealing of endoleaks during or after hospitalisation. By follow-up, 0-30% of patients had an open surgical procedure, most often a conversion to standard open surgical repair. Perioperative mortality ranged from 0-36%. Overall mortality on follow-up ranged from 0.6-23%. Complications ranged from 10-31% of total patients across studies, whereas individual complications occurred in 0.6-20% of patients. If aneurysms were successfully excluded, there appeared to be no subsequent increase in aneurysmal size and possibly a decrease at least in the short-term. Long-term follow-up is necessary to detect the possibility of late developing endoleaks. There has been little systematic study of variables related to health care costs. Expected lengths of stay ranged from 3.8 to 11.5 days. Comparative studies of endovascular repair to alternative interventions are very few, and with significant methodological limitations. Existing evidence reported less blood loss, shorter duration of ICU stay, and a higher incidence of local/vascular complications with endovascular repair than with standard surgery. Little systematic research has been conducted on factors that can affect the outcomes of endovascular repair of AAAs. Short proximal aneurysm neck length may be associated with an increased risk of endoleaks, whose presence risks aneurysmal rupture. More complex aneurysms may be associated with a higher risk of complications, as well as longer operative times and hospital stays.

Authors' recommendations: The currently available literature represents studies that are methodologically inadequate to definitively answer the questions addressed in this report. A critical issue in the evaluation of endovascular repair of AAA will be similar to that for other minimally invasive procedures: does the availability of a minimally invasive treatment option lead to over-utilization of that procedure in patients with marginal indications for surgery?

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www4.va.gov/VATAP/docs/EndovascularlyPlacedGraftsAAA1999tagm.pdf

Year Published: 1998

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: VA Technology Assessment Program

Contact Address: Liz Adams, VA Technology Assessment Program, Office of Patient Care Services (11T), VA Boston Healthcare System Room 4D-142, 150 South Huntington Avenue, Boston, MA 02130 USA Tel: +1 617 278 4469; Fax: +1 617 264 6587;

Contact Name: elizabeth.adams@med.va.gov

Contact Email: elizabeth.adams@med.va.gov

Copyright: U. S. Department of Veterans Affairs