SynthesisThe British journal of surgery2017
Meta-analysis of individual-patient data from EVAR-1, DREAM, OVER and ACE trials comparing outcomes of endovascular or open repair for abdominal aortic aneurysm over 5 years.
Synthesis in The British journal of surgery, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to 5 registered trials, which are not on this map. Cited by 132 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
CSP #498 - Open Versus Endovascular Repair (OVER) Trial for Abdominal Aortic Aneurysms
ACE Trial :Not Worn-Out Aneurism of the Abdominal Aorta Under Renal " Surgery Versus Endoprosthesis "
Endovascular Versus Transabdominal Treatment of the Abdominal Aortic Aneurysm: the Dutch Randomised Endovascular Aneurysm Management (DREAM-) Trial
Secondary Rupture of Aortic Aneurysm After EVAR Management
Deep-learning Prediction of Abdominal Aortic Aneurysm Enlargement in Type II Endoleak After EVAR: Development and Multicenter Validation of an End-to-end Deep-learning Model (the RADAR Study)
Who cites it
132 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Long-term Cardiovascular and All-Cause Mortality following Elective Infrarenal Repair of the Abdominal Aortic Aneurysm: A Systematic Review and Meta-analysis.Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists · 2026Pooled it
- Surgery for small asymptomatic abdominal aortic aneurysms.The Cochrane database of systematic reviews · 2020Pooled it
- Morphological suitability for endovascular repair, non-intervention rates, and operative mortality in women and men assessed for intact abdominal aortic aneurysm repair: systematic reviews with meta-analysis.Lancet (London, England) · 2017Pooled it
- Comparative clinical effectiveness and cost effectiveness of endovascular strategyBMJ (Clinical research ed.) · 2017Trial
- Endoleak type IIIb not always recognized.Journal of vascular surgery cases and innovative techniques · 2026Article
- Targeting the sac or the feeders? An anatomy-driven review of contemporary embolization strategies of type II endoleaks.CVIR endovascular · 2026Review
- Present-Day State of Percutaneous Endovascular Aortic Aneurysm Repair.Journal of clinical medicine · 2026Review
- Proximal sealing length change inversely correlates with the sac size change in patients with sac enlargement associated with type Ⅱ endoleak after endovascular aneurysm repair.Surgery today · 2026Article
- Post-EVAR Endoleaks: A Morphovolumetric Approach to Prediction, Surveillance, and Management.Journal of clinical medicine · 2026Article
- Collagen-Based Vascular Closure Device Multicenter Italian Experience in Endovascular Aortic Aneurysm Repair Compared With Suture-Mediated Closure Vascular Device.Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists · 2026Observational
- An Overview of the Diagnostic and Treatment Strategies for Aortic Disease.Reviews in cardiovascular medicine · 2026Review
- Expression of Circulating MicroRNA before and after Abdominal Aneurysm Repair.Journal of vascular research · 2026Article
- The Present and Future of Zone 0 Endovascular Arch Reconstruction.Journal of cardiovascular development and disease · 2026Review
- Cost Analysis of Abdominal Aortic Aneurysm Repair: The Economic Impact of Rising Surgical Material Costs on Public Health Insurance.Annals of vascular diseases · 2026Article
- Systematic Review of Renal Outcomes and Procedural Efficacy of Carbon Dioxide Digital Subtraction Angiography in Endovascular Aortic Repair.EJVES vascular forum · 2026Review
- Low-Profile AlturaJournal of clinical medicine · 2025Article
- Long-Term Outcomes of the Aorfix™ Stent Graft in Japanese Patients with Severely Angulated Aortic Necks: A Single-Center Retrospective Study.Journal of clinical medicine · 2025Article
- Thoracoabdominal Aortic Aneurysm Repair Using Fenestrated and Branched Endovascular Grafts for High-Risk Patients: Evolving yet Safe.Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists · 2025Article
- The Operative Role of Artificial Intelligence in Vascular Surgery: A Systematic Review of Literature.Cureus · 2025Review
- Endurant Stents in Abdominal Aortic Aneurysm Repair: A Systematic Review and Meta-Analysis.Journal of clinical medicine · 2025Review
72 more citing papers are in PubMed but not listed here.
Corrections and comments
- Erratum issuedCorrigenda.2018
Authors and funding
8 authors.
Funding
Abstract
backgroundThe erosion of the early mortality advantage of elective endovascular aneurysm repair (EVAR) compared with open repair of abdominal aortic aneurysm remains without a satisfactory explanation.
methodsAn individual-patient data meta-analysis of four multicentre randomized trials of EVAR versus open repair was conducted to a prespecified analysis plan, reporting on mortality, aneurysm-related mortality and reintervention.
resultsThe analysis included 2783 patients, with 14 245 person-years of follow-up (median 5·5 years). Early (0-6 months after randomization) mortality was lower in the EVAR groups (46 of 1393 versus 73 of 1390 deaths; pooled hazard ratio 0·61, 95 per cent c.i. 0·42 to 0·89; P = 0·010), primarily because 30-day operative mortality was lower in the EVAR groups (16 deaths versus 40 for open repair; pooled odds ratio 0·40, 95 per cent c.i. 0·22 to 0·74). Later (within 3 years) the survival curves converged, remaining converged to 8 years. Beyond 3 years, aneurysm-related mortality was significantly higher in the EVAR groups (19 deaths versus 3 for open repair; pooled hazard ratio 5·16, 1·49 to 17·89; P = 0·010). Patients with moderate renal dysfunction or previous coronary artery disease had no early survival advantage under EVAR. Those with peripheral artery disease had lower mortality under open repair (39 deaths versus 62 for EVAR; P = 0·022) in the period from 6 months to 4 years after randomization.
conclusionThe early survival advantage in the EVAR group, and its subsequent erosion, were confirmed. Over 5 years, patients of marginal fitness had no early survival advantage from EVAR compared with open repair. Aneurysm-related mortality and patients with low ankle : brachial pressure index contributed to the erosion of the early survival advantage for the EVAR group. Trial registration numbers: EVAR-1, ISRCTN55703451; DREAM (Dutch Randomized Endovascular Aneurysm Management), NCT00421330; ACE (Anévrysme de l'aorte abdominale, Chirurgie versus Endoprothèse), NCT00224718; OVER (Open Versus Endovascular Repair Trial for Abdominal Aortic Aneurysms), NCT00094575.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.