EVAR vs Open Repair for Aortic Aneurysm: Systematic Review with ☸️SAIMSARA.

• Generated: 2026-02-13 10:59:40 CET
• Plan: Pro (expanded craft tokens; source: Europe PMC)
• Source: Europe PMC
• Scope: Titles/Abstracts (tiab)
• Keyword Gate: Fuzzy (≥60% of required terms, minimum 2 terms matched in title/abstract)
• Total Abstracts/Papers: 1950
• Downloaded Abstracts/Papers: 1950
• Included original Abstracts/Papers: 1139
• Total study participants (naïve ΣN): 4532063

• Bias: Qualitatively inferred from study design fields.

• Short-term mortality benefit for EVAR: 30-day mortality EVAR 0.3–2.6% vs OR 2.4–6.72% (OR 0.39–0.66; [[3],[12],[28],[30],[32],[58]]).
• Long-term survival equivalence: 5-year survival EVAR 57–85.7% vs OR 60–93.7% (HR 0.95–1.21, no difference; [[1],[22],[34],[36],[47],[54],[59],[61],[75]]).
• Reintervention higher in EVAR: Rates EVAR 9.7–20.2% vs OR 0–8% at 3–5 years (RR 1.26–2.27, p<0.05; [[3],[8],[26],[32],[34],[47],[55],[64]]).
• Complex aneurysm short-term EVAR advantage: FB-EVAR 30-day mortality 1.5–3.4% vs OR 1.9–6.5% (no difference, lower MAEs OR 0.10–0.44; [[2],[4],[47],[56],[135]]).
• Ruptured cases EVAR favored: 30-day mortality EVAR 5.9–37.5% vs OR 41–63.3% (OR 0.39–0.74; [[16],[28],[52],[58],[69],[70],[80]]).
• Renal complications: Permanent dialysis EVAR 0.42–0.70% vs OR 0.28–0.98% (OR 2.38–3.29 suprarenal; [13],[240],[376],[480]).
• Quality of life early OR detriment: OR greater early QOL impact (-3.4) vs EVAR (-0.8/-0.9), p=0.001; improvement at 6–12 months both [9],[53].
• Octogenarians EVAR safer: 30-day mortality EVAR 6% vs OR 9%, complications 24% vs 53% [[22],[51],[136],[192],[298],[337],[342]].
• Women higher mortality: Elective EVAR adjOR 1.55–1.61 vs men; both repairs disadvantaged [[24],[37],[62],[232],[352],[377],[560]].
• Mycotic aneurysms mixed: EVAR short-term survival better (96% vs 74% 3-month [1]), but reinfection higher (42% vs 18%); individualized [1],[17],[31],[68].

• Prioritize EVAR for ruptured/high-risk/octogenarian patients to minimize 30-day mortality (OR 0.39–0.74; [16],[28],[69],[70]).
• Reserve OR for young/low-risk/complex durable needs, given lower reinterventions (RR 0.31–0.78; [1],[32],[47]).
• Enhanced surveillance post-EVAR essential due to higher reintervention (9.7–26.6%; [3],[8],[36],[55]).
• Women may warrant cautious EVAR selection (adjOR 1.55 mortality; [24],[352]).
• FB-EVAR viable for juxtarenal/complex, matching OR short-term (mortality 1.9–3.4%; [47],[56]).

• Long-term RCTs comparing EVAR vs OR in ruptured AAA (endpoints: aneurysm-related mortality >5 years; [16],[28],[707]).
• Head-to-head trials of FB-EVAR vs OR in young patients with juxtarenal AAA (reintervention-free survival at 10 years; [2],[6],[47]).
• Prospective studies on sex-specific outcomes post-EVAR/OR (perioperative mortality, neck anatomy role; [24],[352],[560]).
• Cost-effectiveness analyses incorporating reintervention in complex/mycotic aneurysms (QALYs, lifelong surveillance; [5],[30],[59]).
• Imaging biomarkers predicting EVAR failure (e.g., neck dilation, endoleak risk; [127],[323],[380]).

• Heterogeneous populations — Studies span infrarenal/simple to complex/juxtarenal/ruptured/mycotic AAA, limiting direct EVAR-OR comparisons across subgroups [2],[3],[16].
• Predominance of retrospective/mixed designs — ~90% non-randomized, risking selection bias (e.g., EVAR for higher-risk patients) [3],[8],[12].
• Short/median follow-up — Most ≤5 years, underpowering late rupture/reintervention detection (typical 1–3 years) [9],[15],[22].
• Variable outcome definitions — Mortality timing (30-day/in-hospital), reintervention scope inconsistent, hindering pooling [3],[32],[47].
• Limited RCTs — Few head-to-head trials (e.g., [2]), with small samples/low power for rare events like rupture [3],[28].

• RCT ruptured complex AAA — EVAR vs OR, primary endpoint aneurysm-related mortality at 5 years, powered for subgroups.
• Prospective neck imaging registry — Track dilation/endoleak in EVAR vs OR, benchmark 10-year reintervention.
• Sex-stratified multicenter trial — EVAR vs OR in women, endpoints perioperative mortality and QOL at 2 years.
• Cost-QALY model update — Incorporate FB-EVAR reinterventions, real-world surveillance costs over lifetime.
• Biomarker validation study — Preoperative EVs/L-FABP predict post-EVAR AKI/endoleak, benchmark vs standard creatinine.