Aorto-Uni-Iliac Versus Bifurcated Endograft Configuration for Endovascular Repair of Ruptured Abdominal Aortic Aneurysm: A Systematic Review and Meta-analysis.

OBJECTIVE: To compare perioperative outcomes between aorto-uni-iliac (AUI) and bifurcated (BIF) endograft configurations in patients undergoing endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysm (rAAA). METHODS: PubMed, Embase, and Web of Science were searched for studies comparing AUI and BIF endografts in the treatment of rAAA. A total of 373 studies were screened in accordance with the PRISMA guidelines. Pooled analyses were performed using random-effects meta-analysis, and effect sizes were reported as risk ratios (RRs) or mean differences (MDs) with 95% confidence intervals (CIs). Statistical significance was defined as p < 0.05. Leave-one-out sensitivity analyses were performed. RESULTS: Six cohort studies comprising 799 patients (23.5% female) were included, of whom 243 (30.4%) underwent EVAR with an AUI configuration. There was no statistically significant difference between AUI and BIF groups in 30-day mortality (RR, 1.62; 95% CI, 0.89-2.97), postoperative myocardial infarction, abdominal compartment syndrome, dialysis requirement, conversion to open repair, or operative time. Sensitivity analyses demonstrated that exclusion of individual studies altered the pooled effect estimate for 30-day mortality, favoring BIF configuration. CONCLUSION: Among patients undergoing EVAR for ruptured abdominal aortic aneurysm, perioperative outcomes did not differ significantly between AUI and BIF endograft configurations. Although sensitivity analyses favored BIF, the overall findings suggest that graft configuration alone may play a limited role in determining rAAA surgical outcomes.