Fewer Deaths with Nonsurgical Treatment of Abdominal Aortic Aneurysms

A new study comparing different approaches for patients with abdominal aortic aneurysm (AAA) shows nonsurgical treatment results in a far lower mortality rate than open surgery.

Researchers at Erasmus Medical Center (Rotterdam, The Netherlands) conducted a trial involving a total of 1,252 patients who were randomized to either minimally invasive endovascular treatment or open surgical repair. The results showed that 30-day mortality was significantly lower (1.8% ) in the patients randomized to the less invasive endovascular treatment, compared to 4.3% in those that underwent open surgery. After a 6-year follow-up period, no difference in mortality between the two groups was observed.

The study also confirmed that the initial cardiac event rate, myocardial infarction (MI), and cardiac death after open surgical repair can be effectively reduced using an extended release fluvastatin (statin) therapy, aiming at coronary plaque stabilization. The effect was present in patients with normal or moderately elevated LDL-cholesterol levels, and was associated with reductions of interleukin-6 and high-sensitive C-Reactive Protein (CRP). The results of the study were presented at the 37th VEITH symposium, held during November 2010 in New York (NY, USA).

"These patients might be considered candidates for open surgical repair, compared to those with an unfavorable response to fluvastatin who might benefit from a procedure with less cardiac stress such as endovascular therapy, which is less invasive than vascular surgery," said lead author and study presenter Prof. Don Poldermans, MD, PhD, of the department of perioperative cardiac care.

The study also found that patients with low CRP had a favorable long-term prognosis after open repair, while those with a high sensitivity to CRP had a poor prognosis, primarily within the first postoperative month. The researchers concluded that despite optimal medical threat, patient selection based on high CRP sensitivity might reveal a group of patients that should be offered endovascular rather than open abdominal aortic aneurysm repair, and that these patients may have a long-term benefit from endovascular repair.

Related Links:
Erasmus Medical Center