Effectiveness and safety of endovascular repair versus open repair for abdominal aortic aneurysms：a systematic review and meta-analyses of randomized controlled trials JIE Yue-gao, LUO Jun, TIAN Ye, et al. The First Affiliated Hospital of Xin Jiang Medical University, Urumqi 830054, China Corresponding author:LUO Jun , E-mail:xmuluo@163.com Abstract Objective To evaluate the efficacy and safety of ER compared with OR for AAA. Methods We searched MEDLINE (OVID, 1990 to 2008), EMBASE.com (1990 to 2008), Cochrane Central Register of Controlled Trials (1991 to October 2008), PubMed ( 1990 to 2008), Chinese Biomedical Literature Database (CBM), Chinese Scientific Journal Full-text Database (CSJD), and Chinese Journal Full-text Database (CJFD), added with handsearching and other retrievals.The Cochrane Collaboration’s RevMan 5.0.18 was used for meta-analyses. Results Four RCTs including 6 literatures reporting data on safety and efficacy of ER versus OR were included. Meta-analyses showed that ER was superior to OR as measured by the 30-day all cause mortality (OR 0.32; 95%CI 0.16 to 0.62; P=0.0008) and mid-term AAA-cause mortality (OR 0.50, 95%CI 0.30 to 0.85; P=0.010) . Mid-term all-cause mortality: ER was similar with open repair (OR 0.91, 95%CI 0.69 to 1.19; P=0.48). About mid-term all-complication, no significant difference was observed between ER and OR (OR 2.51, 95%CI 0.48 to 13.04; P=0.27). OR was superior to ER as measured by the reintervation rate (OR 2.2; 95%CI 1.67 to 2.88; P<0.00001). DREAM and EVAR-1 showed that OR was superior to ER as measured by the one-month and nine-month reintervation rate (OR 1.76; 95%CI 1.10 to 2.80; P=0.02) and (OR 2.59; 95%CI 1.10 to 6.10 P=0.03). Conclusions The short-term efficacy of ER is better than OR on the treatment of infrarenal and unruptured aortic aneurysms. Although the mid-term all-cause mortality is similar: the risk of reintervation rate is higher than ER. Those mean that the reasonable selection is very important.