Systematic review and meta-analysis of long-term interventional therapy after in-cavity aneurysm repair

Patients receiving in-cavity aneurysm repair (EVAR) often need to be re-involved.
is little known about the long-term rate of re-intervention and whether new equipment technology has changed the outcome.
, the researchers conducted a systematic review and meta-analysis of the available literature to determine the long-term degree of freedom and re-intervention rates of EVAR intervention over time.
researchers conducted a systematic review of MEDLINE, Embase, Cochrane Library, and ClinicalTrials.gov based on the entries of the System Review and Meta-Analysis Priority Report (PRISMA).
included randomized controlled trials and observational studies that recorded EVAR re-intervention rates.
researchers analyzed the annual Kaplan-Meier re-intervention rate after EVAR.
use linear regression to evaluate changes in re-intervention rates under new device technology over time.
results were incorporated into 30 studies (randomized trials, n-3; observational studies, n-27), and included 32,126 patients in this review and meta-analysis.
study ranged from 1996 to 2014 for implantation of EVAR devices.
81% (95% CI 77% to 85%), 70% (95% CI 65% to 76%) in 10 years, and 64% (95% CI 46% to 79%) in 14 years.
linear regression showed that there was an improvement in no intervention rate when the results were layered by device implant year.
year after surgery, the estimated rate of non-intervention increased from 90 per cent in 1998 to 94 per cent in 2008 (n-26 studies; R2-0.11; P-0.10).
three years after surgery, the estimated re-intervention rate increased from 77 per cent in 1998 to 90 per cent in 2008 (n-26 studies; R2-0.27; P-0.006).
five years after surgery, the estimated re-intervention rate increased from 68 per cent in 1998 to 81 per cent in 2008 (n-22 studies; R2-0.12; P-0.12).
seven years after surgery, the estimated re-intervention rate increased from 51 per cent in 1998 to 86 per cent in 2011 (n-22 studies; R2-0.40; P-0.015).
patients with EVAR are still at risk of re-intervention and must be monitored for life.
, however, the rate of re-intervention has improved over time, as new equipment has led to lower rate of re-intervention.
re-intervention rate remains an important indicator of new equipment and registries.