Weighing Aneurysm Surgery Options

Patients Have Better Short-Term Survival With Endovascular Surgery

From the WebMD Archives

Aug. 24, 2004 -- About two-thirds fewer abdominal aortic aneurysm patients died in the month after getting endovascular surgery than those who had conventional open surgery, according to a new study in the British journal The Lancet.

Abdominal aortic aneurysm is a dangerous swelling of the abdominal aorta -- the major artery of the body, which carries blood from the heart to the rest of the body. An aneurysm is a permanent enlargement of an artery. If the abdominal aorta swells too much, it can burst, which is usually fatal.

Surgery is done on large aneurysms to prevent rupture and prolong life; small aneurysms are monitored regularly.

For more than 50 years, aortic aneurysms have been treated by surgery through a large incision into the abdomen. A new technology, endovascular aneurysm repair, is much less invasive, resulting in a shorter hospital stay and quicker recovery. With this newer technique, a surgeon can repair a large aneurysm through a small incision in the groin. This incision allows surgeons to pass a small, tightly wrapped graft into the area of the aneurysm, which strengthens the weakened artery.

Professor Roger Greenhalgh of Imperial College in London led a study comparing the two procedures. More than 1,000 patients with large abdominal aortic aneurysms (at least 5.5 centimeters, or about 2.17 inches) took part.

Participants were all at least 60 years old, and almost all (91%) were men. Forty-one British hospitals participated in the study.

Participants were assigned to have either open surgery or endovascular aneurysm repair.

In the 30 days following the procedures, about two-thirds fewer endovascular surgery patients died than those who had conventional open surgery.

"We have shown a clear short-term survival benefit of endovascular aneurysm repair, with 1.7% of patients dying by 30 days compared with 4.7% of those allocated open repair," write the researchers.

The endovascular surgery patients also had shorter surgery time and spent less time in the hospital. But they needed follow-up treatment more often than the open surgery group.

Almost 75% more secondary procedures, such as repairing leaks and other surgeries, were needed within 30 days of endovascular aneurysm repair.

Open surgery is much more invasive and requires general anesthesia. However, the graft used to repair the aneurysm generally lasts about 20-30 years, which covers the rest of most patients' lives.

People at risk for abdominal aortic aneurysm are those greater than 60 years old, smokers, people with high blood pressure and atherosclerosis (the hardening of the arteries), and people with a family history of abdominal aortic aneurysm.

More research is needed to determine which procedure is better in the long run, say the researchers.

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SOURCES: Greenhalgh, R. The Lancet, Aug. 25, 2004 (online edition). News release, The Lancet.
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