Complications Post Endovascular Abdominal Aortic Aneurysm Repair in Patients with Diabetes Mellitus: A Meta-analysis and Systematic Review

Background People with diabetes mellitus (DM) have higher long-term mortality following abdominal aortic aneurysm (AAA) repair than those without DM. However, whether this adverse outcome is directly related to their aneurysm is unclear. Aims To determine the rates of complications in people with and without DM post endovascular abdominal aortic aneurysm repair. Primary outcome data include AAA sac enlargement, reinterventions, endoleaks, post-operative AAA rupture and conversion to open surgical repair. Methods PubMed, Embase and Cochrane databases were searched for primary research studies between 2005 and 2023 according to PRISMA guidelines. Those undergoing AAA repair via endovascular aneurysm repair were included. Results Thirty-five studies were identified totalling 90,347 people in the control group, and 17,660 in the DM group. Those with DM had a lower rate of reintervention compared to controls (9.94% v 11.58%; OR 0.89, 95% CI [0.82-0.97]; P=0.005), however there was no significant difference in the rate of overall, type I or type II endoleaks (P=0.22, P=0.29, P=0.15 respectively). People with DM were also less likely to have sac enlargement post AAA repair (9.66% v 11.27%; OR 0.79, 95% CI [0.68-0.93]; P=0.003). Additionally, people with DM had a significantly reduced rate of conversion to open surgery (2.11 % DM v 3.12% control; OR 0.80, CI [0.66-0.97]: P=0.02). Conclusion Reinterventions, sac enlargement post AAA repair, and conversion to open surgical repair were significantly lower in people with DM, however the cause for these differences remains unclear.