Less-invasive technique has improved outcomes of aortic aneurysm repair

A shift toward a less-invasive endovascular procedure as an alternative to conventional surgery has reduced the risk of death for patients undergoing repair of dangerous abdominal aortic aneurysms (AAAs), reports a study in the March Journal of Vascular Surgery.

"Our results show that vascular surgeons are saving more lives through the increased use of endovascular AAA repair–even while operating on older and less-fit patients," said Dr. Ellen D. Dillavou, Assistant Professor of Vascular Surgery at University of Pittsburgh, one of the study authors. Dr. Dillavou and colleagues used Medicare data to analyze trends in AAA surgery from 2000 to 2003.

Abdominal aortic aneurysm is a ballooning of the aorta, the body’s large central artery, resulting from a weakening or stretching of the vessel wall. If the aneurysm ruptures (bursts), it is usually fatal. If detected through proper screening, AAAs can be repaired to prevent rupture. However, traditional open surgery for AAA is a major operation with a significant risk of death and prolonged recovery time.

Endovascular aneurysm repair (EVAR) provides a less-invasive alternative to open surgery for AAA repair. In this procedure, the vascular surgeon makes a small incision in the groin to thread a catheter through the patient’s arteries. Once the catheter reaches the location of the AAA, a device called a stent-graft is placed, expanded, and fixed in place to repair the aneurysm.

During the period studied, AAA repair was performed in about 28,000 elderly Medicare patients per year. The use of EVAR increased steadily after 2000, the first year Medicare recognized the procedure. By 2003, EVAR made up more than 40 percent of AAA repairs.

The risk of death was significantly lower with EVAR: 1.9 percent, compared to 5.2 percent for patients undergoing conventional open surgery. Reflecting the increased use of EVAR, the overall mortality rate after AAA repair decreased from 5.0 to 3.7 percent from 2000 to 2003.

Compared to open surgery, patients undergoing EVAR required less recovery time in the hospital and intensive care unit. They were also less likely to be sent to a nursing home or other care facility after leaving the hospital. The improvement in results of AAA repair occurred despite the fact that the average patient age increased during the study period.

"Our study shows excellent results for EVAR, with less than two percent mortality in a nationwide sample," said Dr. Dillavou. "These outstanding results have influenced the outcomes of AAA repair overall. This means that AAA repair can be performed with fewer operative deaths, shorter hospital stays, and a faster return home."