"These results lend support to what surgeons have thought about minimally invasive repair since its inception. We can now tell patients there is some data to support the notion that the less invasive approach is safer and requires a shorter hospital stay than traditional surgery," says the study's senior author, Dr. Craig Kent, chief of vascular surgery at NewYork-Prebyterian Hospital and professor of surgery at Columbia and Weill Medical College of Cornell University.
Abdominal aortic aneurysms occur when the aorta's walls weaken and the vessel bulges out. Aneurysms usually affect people over age 60, and most cases occur in men. It is estimated that about 15,000 Americans die from ruptured abdominal aneurysms each year, but the actual number may be much higher because of undiagnosed cases.
Traditionally, abdominal aneurysms have been repaired by opening the abdomen, removing the diseased section and then reinforcing the vessel with an artificial graft. Not all patients with an aneurysm can withstand the ordeal of such surgery, however, so a less invasive technique was developed.
In 2000, Medicare started paying for a less invasive, endovascular technique in which a stent is guided into the aorta through an artery in the leg and placed in the aneurysm.
The new study found that by 2002 the endovascular procedure resulted in less in-hospital mortality than the open procedure (0.8 percent versus 4.2 percent) and fewer postoperative complications. Surprisingly, the mortality was lower even though the endovascular patients were generally older and sicker than the open surgery patients. The results were published in the January issue of the Journal of Vascular Surgery.
The study's authors warn, however, that they could not determine mortality rates once the patients left the hospital and since endovascular repair is a relatively new procedure they still don't know how the grafts hold up over time. "These are exciting early results, but we need to follow these patients to see how they do in the long term," says one of the researchers, Dr. Patrice Anderson, post-doctoral research fellow, of CUMC's International Center for Health Outcomes and Innovation Research.
"It's a good alternative for people who can't tolerate the open procedure, but for younger and healthier people an open procedure may still be a better option," Dr. Anderson says.