Study Compares Abdominal Aortic Aneurysm Repair Methods
TUESDAY Oct. 13, 2009 -- A less-invasive method of abdominal aortic aneurysm (AAA) repair reduces the short-term risk of death, according to a new U.S. study.
The interim findings are from a nine-year multicenter trial comparing patient outcomes after endovascular and open surgical repair of AAA. The report included postoperative outcomes of up to two years (average 1.8 years of follow-up) for 881 patients, aged 49 or older, who had endovascular repair (444) or open repair (437).
Endovascular repair is performed through a catheter inserted into an artery. Open repair involves an abdominal incision. Of the 45,000 patients in the United States who undergo elective repair of an unruptured AAA each year, more than 1,400 die in the perioperative period -- the first 30 days after surgery or inpatient status. There's limited data available about whether short-term survival is better after endovascular repair compared to open repair.
The interim study found that the rate of death after surgery was lower for the endovascular group than for the open surgery group at 30 days (0.2 percent versus 2.3 percent) and at 30 days or during hospitalization (0.5 percent versus 3 percent). There was no significant difference in all-cause death at two years (7 percent versus 9.8 percent) or in death after the perioperative period (6.1 percent versus 6.6 percent).
The researchers also found that patients in the endovascular repair group spent less time in surgery, lost less blood, and spent less time on mechanical ventilation.
"Hospital and ICU stays were shorter with endovascular repair and need for transfusion was decreased. No significant differences were observed in major morbidities, secondary procedures, or aneurysm-related hospitalizations," wrote Dr. Frank A. Lederle, of the Veterans Affairs Medical Center, Minneapolis, and colleagues. "Longer-term data are needed to fully assess the relative merits of the two procedures."
The study appears in the Oct. 14 issue of the Journal of the American Medical Association, a theme issue on surgical repair.
The Society for Vascular Surgery has more about abdominal aortic aneurysm.
Posted: October 2009
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