Williamson JS, et al. - Researchers aimed at characterizing the risk and consequences of colon ischaemia (CI) in elective abdominal aortic aneurysm (AAA) repair comparing endovascular (EVAR) with open (OR) repair. A reduced incidence of CI was noted in association with EVAR compared with OR.

Methods

• Researchers performed a systematic review and meta-analysis of the literature using the Cochrane collaboration protocol and reported according to the PRISMA guidelines.
• They searched PubMed, MedLine, and EMBASE for studies reporting CI rates after elective AAA repair.
• They excluded ruptured AAAs from analysis.

Results

• Researchers included 13 studies reporting specific outcomes of CI after elective AAA repair.
• The studies contained 162,750 evaluable patients (78,151 EVAR and 84,599 OR).
• All studies found that compared to EVAR, OR had a higher risk of CI.
• Confounder adjustment was performed in three studies with CI rates of 0.5–1% vs 2.1–3.6% (EVAR vs OR) and combined odds ratio of 2.7 (2.0–3.5) for the development of CI with OR vs EVAR.
• Cases of CI emerged within 30 days, in majority; these were associated with variable mortality (0–73%) and re-intervention rates (27–54%).
• For all outcomes, GRADE assessment of evidence strength was very low.
• A high degree of heterogeneity was noted between studies both methodologically and in terms of CI rates, re-intervention, mortality, and time to development of CI.