Endovascular stents for abdominal aortic aneurysms: a systematic ...

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Assessment of clinical effectivenessStudyIRFvan Eps 2006 88Not IRFButh 2000 64Sample sizeData sourceStudy dates5167EUROSTAR1996–20051554EUROSTAR1994–1999FIGURE 43 Aneurysm size and 30-day mortality. Studies to the left of the vertical line found pre-existing conditions to be anindependent risk factor (IRF), whereas those to the right did not.StudyPeppelenboschTorella 2004 87Zarins 2006 90 Lifeline 2005 79IRFBrewster2006 61Not IRFLeurs 2004 73Sample sizeData sourceStudy dates4392EUROSTAR1996–20023992EUROSTAR1994–2002961AUS1999–2001923US1998–19992664US[5 years]873US1994–2005676EUROSTAR1998–2004Study2004 82 Boult 2007 60 Not IRFFIGURE 44 Aneurysm size and aneurysm-related mortality. Studies to the left of the vertical line found pre-existing conditions to be anindependent risk factor (IRF), whereas those to the right did not.Brewster Leurs Buth 2002 652006 61 2004 73Lifeline Boult2002 78 2007 60Leurs 2007 72ZarinsIRFLifeline2005 792006 90 2664Sample sizeData sourceStudy dates873US1994–2005676EUROSTAR1998–20043075EUROSTAR1996–1646USNot reported961AUS1999–20011033EUROSTAR1999–923US1998–1999US[5 years]66FIGURE 45 Aneurysm size and all-cause mortality. Studies to the left of the vertical line found pre-existing conditions to be anindependent risk factor (IRF), whereas those to the right did not.
DOI: 10.3310/hta13480 Health Technology Assessment 2009; Vol. 13: No. 48IRFNot IRFStudyBoult 2007 60Zarins 2006 90Sampram2003 85a Torella 2004 87Pepplenbosch2004 82b Cuypers2000 67Hobo 2006 69Sample sizeData sourceStudy dates961AUS1999–2001923US1998–1999703US1996–20023992EUROSTAR1994–20024392EUROSTAR1996–20021871EUROSTAR1994–19992846EUROSTAR1999–2004a, Late conversion to open repair; b, conversion to open repair only.FIGURE 46 Aneurysm size and reintervention. Studies to the left of the vertical line found pre-existing conditions to be an independentrisk factor (IRF), whereas those to the right did not.IRFNot IRFStudya Boult 2007 60 Ruppert Mohan 2001 812006 84Leurs 2005 75 b Boult 2007 60c Mohan2001 81van Marrewijk2004 89Buth 2000 64Sample sizeData sourceStudy dates961AUS1999–20015557EUROSTAR1997–20042146EUROSTAR1994–20004233EUROSTAR1994–2004961AUS1999–20012146EUROSTAR1994–20003595EUROSTAR1996–20021892EUROSTAR1994–2000a, Type I endoleak; b, type II endoleak; c, proximal endoleak.FIGURE 47 Aneurysm size and endoleak. Studies to the left of the vertical line found pre-existing conditions to be an independent riskfactor (IRF), whereas those to the right did not.All-cause mortalityIncreasing age had a self-evident role in all-causemortality, but there is no indication of any linkbetween female gender and this outcome. Themajority of studies found that pulmonary status/COPD was an independent risk factor for all-causemortality after EVAR but evidence was lacking orinconsistent on other comorbidities. The balanceof evidence did suggest that renal impairment isan independent risk factor for all-cause mortality.With the exception of a large US study, all analysesfound ASA status to be an independent risk factorfor all-cause mortality. The very limited evidence© 2009 Queen’s Printer and Controller of HMSO. All rights reserved.suggests that smoking status is not associated withadverse outcomes after EVAR. Aneurysm size islikely to be an independent risk factor for all-causemortality but the balance of evidence suggestsno effect of aortic neck and aneurysm angle. Theevidence regarding graft configuration/device typeand all-cause mortality was too limited to drawconclusions.ReinterventionThe evidence suggests that age and gender werenot risk factors for reintervention. The availableanalyses also suggest that diabetes is not a risk67
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Health Technology Assessment 2009;
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Endovascular stents for abdominal a
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Executive summaryxivResultsClinical
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Discussion140We attempted to obtain
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Discussionevaluation to date of pol
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Conclusions• Opportunities for in
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Appendix 1164S28 16 RETA/TI,ABS29 0
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Appendix 116650. (EUROSTAR and (eva
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Appendix 116844. endovascular repai
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Appendix 1MEDLINEVia OvidSearched 1
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Appendix 2TABLE 75 Checklist for Pa
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Appendix 2TABLE 81 Checklist for EV
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FeedbackThe HTA programme and the a
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