Endovascular AAA Repair Superior to Open Surgery

Less invasive endovascular abdominal aortic aneurysm (AAA) repair leads to better long-term survival, according to a new study.

Researchers at Massachusetts General Hospital (MGH; Boston, MA, USA), the University of California Irvine (UCI; USA), and other institutions conducted an analysis of the longitudinally linked California Office of Statewide Health Planning and Development inpatient database from 2001 to 2009 to determine long-term outcomes of endovascular versus open repair on a population level. The observational study included 23,670 patients, of whom 52% received endovascular AAA repair. The main outcomes and measures were mortality and complications at 30 days, as well as long-term mortality and complications at up to 9 years.

The results showed that endovascular repair was associated with improved 30-day outcomes, as well as significantly improved survival up to three years postoperatively. After three years, mortality was higher for patients who underwent an endovascular repair, but no significant difference in long-term mortality was observed for the entire cohort on an adjusted analysis. The researchers also found that endovascular repair was associated with a significantly higher rate of re-intervention and AAA late ruptures. The study was published online on September 02, 2015, in JAMA Surgery.

“Given that the major risk factor for AAA is smoking, this survival advantage would inevitably erode as cardiovascular disease, emphysema, and pulmonary malignancy exact their toll,” concluded lead author David C. Chang, PhD, of MGH, and colleagues. “After three years, mortality was higher for patients who had endovascular repair. We believe this is explained by the willingness of the surgeon to undertake endovascular repair in older patients knowing that the less invasive procedure is safer than open aortic repair.”

AAA is the localized dilatation of the abdominal aorta exceeding the normal diameter by more than 50%, and is the most common form of aortic aneurysm; approximately 90% occur below the kidneys. The aneurysms can extend to include one or both of the pelvic iliac arteries. The major complication of AAA is rupture, which is life-threatening, as large amounts of blood spill into the abdominal cavity, and can lead to death within minutes. Mortality of rupture repair in the hospital is 60%–90%.

Related Links:
Massachusetts General Hospital
University of California Irvine