GRADE-Based Recommendations for Surgical Repair of Nonruptured Abdominal Aortic Aneurysm

Margarita Posso, M. Jesús Quintana, Sergi Bellmunt, Laura Martínez García, José R. Escudero, Andrés Viteri-García, Claudia Valli, Xavier Bonfill

Research output: Contribution to journalReview articleResearchpeer-review

3 Citations (Scopus)

Abstract

© The Author(s) 2019. The objective of this study was to provide evidence-based recommendations for endovascular aneurysm repair (EVAR) versus open surgical repair (OSR) for patients with a nonruptured abdominal aortic aneurysm (AAA). We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement and adhered to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Both low- and high surgical risk patients treated with EVAR showed decreased 30-day mortality, but the low-risk group had no differences in 4-year mortality. Compared with friendly anatomy, patients with hostile anatomy had an increased risk of type I endoleak. Young patients may prefer OSR. Endovascular aneurysm repair was not cost-effective in Europe. Four conditional recommendations were formulated: (1) OSR for low-risk patients up to 80 years old, (2) EVAR for low-risk patients older than 80 years, (3) EVAR for high-risk patients as long as is anatomically feasible, and (4) OSR in patients in whom it is not anatomically feasible to perform EVAR. Based on GRADE criteria, either OSR or EVAR can be suggested to patients with nonruptured AAA taking into account their surgical risk, hostile anatomy, and age. Given the weakness of the recommendations, personal preferences are determinant.
Original languageEnglish
Pages (from-to)701-710
JournalAngiology
Volume70
Issue number8
DOIs
Publication statusPublished - 1 Sep 2019

Keywords

  • abdominal aortic aneurysm
  • endovascular procedure
  • vascular surgical procedure

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