Having two options available for the repair of ruptured abdominal aortic aneurysms, including an open surgery and a less invasive procedure, is associated with improvement in overall survival after surgery, according to a report in the June issue of Archives of Surgery, one of the JAMA/Archives journals.
Most patients with ruptured abdominal aortic aneurysms—which occur when a segment of the aorta, the large blood vessel that supplies the pelvis, legs and abdomen, enlarges and bursts—do not survive long enough to reach the hospital, according to background information in the article. Among those who do, most patients undergo a procedure known as open graft replacement, in which the aorta is repaired through an open incision and the damaged segment of the aorta is replaced with a synthetic graft. Rates of death following this procedure are approximately 40 percent to 50 percent and have not changed over the past four decades, the authors note.
In 1994, endovascular abdominal aortic aneurysm repair—a minimally invasive procedure in which a mesh stent is inserted through an artery and positioned within the aorta—was introduced as a treatment alternative. Andreas Wibmer, M.D., of the Medical University of Vienna, Austria, and colleagues conducted an analysis of 89 consecutive patients treated for abdominal aortic aneurysms at one center between 1999 and 2006. From 1999 through 2003, 42 patients were treated with open graft replacement. In 2003, the university established a protocol during which some selected patients (16 patients or 34 percent) were instead treated with endovascular abdominal aortic aneurysm repair.
The researchers found that the overall death rates in the 90 days after surgery decreased following the introduction of the endovascular procedure, from 54.8 percent in the first period to 27.7 percent in the second period. Improved survival was most apparent in patients older than 75.5 years. However, the 90-day death rate also decreased for patients undergoing open graft reduction following the introduction of endovascular repair, from 54.8 percent to 29 percent.
"Our findings strongly indicate that the implementation of endovascular abdominal aortic aneurysm repair is able to reduce the overall mortality in patients with ruptured abdominal aortic aneurysm," the authors write. "By offering both treatment options, it was possible to improve the immediate and mid-term overall results by shifting high-risk patients from the open graft reduction to the endovascular abdominal aortic aneurysm repair group, thereby improving the results of open surgery."
"The issue of which subgroup of patients might benefit the most from this less-invasive technique still remains," they continue. In the study, older patients and those who were more hemodynamically stable—those whose blood pressure remained relatively constant—appeared to experience the largest improvements in survival with this treatment option.
(Arch Surg. 2008;143[6]:544-549. Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Journal
Archives of Surgery