Less Invasive Procedure to Repair AAA

Reported October 15, 2009

(Ivanhoe Newswire) -- Patients who received the less-invasive endovascular repair of an abdominal aortic aneurysm had a lower risk of death in the first 30 days after the procedure compared to patients who had an open repair; however, both procedures had similar rates of death after two years, according to a new study.

Each year in the United States, 45,000 patients with unruptured abdominal aortic aneurysm (AAA) undergo elective repair, resulting in more than 1,400 perioperative [the first 30 days after surgery or inpatient status] deaths.

Endovascular repair, performed through a catheter inserted into an artery, was developed to provide a less invasive method than the standard open procedure, which involves an abdominal incision. But "limited data are available to assess whether endovascular repair of AAA improves short-term outcomes compared with traditional open repair," study authors were quoted as saying.

Frank A. Lederle, M.D., of the Veterans Affairs Medical Center in Minneapolis, and colleagues are conducting an ongoing nine-year, multi-center clinical trial to examine outcomes after elective endovascular and open repair of AAA. This interim report includes postoperative outcomes of up to two years for 881 patients. Patients were randomized to either endovascular or open repair of AAA. Average follow-up was 1.8 years.

The researchers found that the rate of death 30 days after surgery was significantly higher for open repair, but there was no significant difference in all-cause death at two years.

Patients in the endovascular repair group had significant reductions in blood loss and duration of mechanical ventilation.

"Hospital and ICU stays were shorter with endovascular repair and need for transfusion was decreased," the authors wrote. "No significant differences were observed in major morbidities, secondary procedures, or aneurysm-related hospitalizations. Longer-term data are needed to fully assess the relative merits of the two procedures."

SOURCE: Journal of the American Medical Association (JAMA), October 14, 2009