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

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. The aim of the study was to determine the rates of complications in people with and without DM post-endovascular AAA repair. Primary outcome data include AAA sac enlargement, reinterventions, endoleaks, postoperative AAA rupture, and conversion to open surgical repair. 

Methods: PubMed, Embase, and Cochrane databases were searched for primary research studies between 2005 and 2025 according to Preferred Reporting Items for Systematic Review and Meta-analyses guidelines. Those undergoing AAA repair via endovascular aneurysm repair were included. 

Results: Forty-four studies were identified totaling 90,347 people in the control group, and 23,988 in the DM group. Those with DM had a lower rate of reintervention compared to controls (9.51% v 11.92%; odds ratio [OR] 0.82, 95% confidence interval [CI] [0.76–0.88; P < 0.001). However, there was no significant difference in the rate of overall, type I or type II endoleaks (P = 0.22, P = 0.237, P = 0.667, respectively).People with DM were also less likely to have sac enlargement post-AAA repair (9.05% DM v 10.38% controls; OR 0.86 [0.78–0.96]; P = 0.005). Those with DM were more likely to have sac shrinkage (42.89% DM v 41.26% controls; OR 0.92, 95% CI [0.89–0.95]; P < 0.001). In addition, people with DM had a reduced rate of conversion to open surgery (2.11% DM v 3.12% control; OR 0.80, CI [0.66–0.97]; P = 0.023). 

Conclusion: Reinterventions, sac enlargement post-AAA repair, and conversion to open surgical repair were associated with a significant reduction in people with DM; however, the cause for these differences remains unclear.