Seventeen relevant retrospective cohort studies (n=589, range 10 to 74 patients) were identified. The reported mean quality score out of 13 was 10.6 (range four to 13).
Procedure-related mortality was significantly lower with TEVAR than with open repair (OR 0.31, 95% CI 0.15 to 0.66, p=0.002; 15 studies). Overall 30-day mortality was significantly lower with TEVAR than with open repair (OR 0.44, 95% CI 0.25 to 0.78, p=0.005; 16 studies). Postoperative paraplegia/paraparesis rate was significantly lower with TEVAR than with open repair (OR 0.32, 95% CI 0.10 to 0.93, p=0.04; nine studies).
Three studies had significantly lower quality scores, but sensitivity tests found pooled odds ratios did not vary significantly with and without these studies included. A funnel plot for 30-day mortality showed little publication bias and the Q-test did not show significant heterogeneity for mortality (p=0.09), procedure-related mortality (p=0.09) and for paraplegia/paraparesis (p=0.08). Random-effects and fixed-effect models gave similar results.
Details were given of the types of endograft used and the techniques used for open repair in the individual studies.