From Our 2010 Archives
Less Invasive Fix for Abdominal Aortic Aneurysm WorksBy Steven Reinberg
WEDNESDAY, May 19 (HealthDay News) -- For patients with an abdominal aortic aneurysm, a less invasive procedure called endovascular repair appears as good as conventional surgery, Dutch researchers report.
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In previous studies, endovascular repair has been shown to have fewer complications and deaths associated with it and the recovery time is much shorter than with open surgery. However, questions remained about whether endovascular repair would result in more deaths over time, the researchers noted.
"We found that endovascular and conventional open repair of abdominal aortic aneurysms have similar overall survival up to seven years postoperatively, but there is a higher rate of long-term re-interventions after endovascular repair," said lead researcher Dr. Jan D. Blankensteijn, from the division of surgery at the Vrije Universiteit Medical Center in Amsterdam.
The report is published in the May 20 issue of the New England Journal of Medicine.
For the study, Blankensteijn's team randomly assigned 351 patients with abdominal aortic aneurysm to endovascular or open surgery.
Six years after the procedures were performed, 69.9% of those who had open repair were still alive as were 68.9% of those who underwent endovascular repair, the researchers found.
Among patients who underwent open repair, some 20% needed another procedure, compared with about 30% of those who had endovascular repair, Blankensteijn's group noted.
"Endovascular repair is better in the short term and there are no survival differences in the long term," Blankensteijn said. "If the extra re-interventions after endovascular repair are well-understood by the patient and incorporated in the decision-making and when both therapies are optional, endovascular repair is the preferred therapy."
Dr. K. Craig Kent, chair of the department of surgery at the University of Wisconsin School of Medicine & Public Health and author of an accompanying journal editorial, said that "in this country about 60% of aneurysms are repaired with the minimally invasive approach whereas about 40% are repaired with the traditional open surgery."
There is still some controversy about which is the best method, Kent said. The advantages to endovascular repair are quicker recovery time both in and out of the hospital, while the disadvantages are the higher cost for the procedure and the need for re-intervention in some patients, he said.
Since the long-term mortality rate for the two procedures is about the same, Kent thinks endovascular repair is the preferred method.
"This is comforting news," he said. "Now we have a treatment that provides a fairly substantial benefit early on and the long-term outcomes are equivalent. If you were a patient you would probably take that minimally invasive approach."
An aortic aneurysm is a bulge in the aorta, the main artery leading away from the heart. As the artery wall weakens and the vessel widens, it can become so weak that it can burst. When this happens, people usually don't survive. In fact, the death rate from a ruptured aortic aneurysm is about 85%. About 30,000 Americans die from ruptured aortic aneurysms each year, Kent explained.
Aortic aneurysms are most common in people over 50. But often, people with an aortic aneurysm don't know it because there are rarely any symptoms. However, aortic aneurysm can be seen using ultrasound and people at risk for them can benefit from screening. Right now, people who were smokers or who do smoke are the most likely candidates for screening, Kent said.
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SOURCES: Jan D. Blankensteijn, M.D., division of surgery, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; K. Craig Kent M.D., professor and chair, department of surgery, University of Wisconsin School of Medicine & Public Health, Madison; May 20, 2010, New England Journal of Medicine