Less Invasive Surgery Repairs Aortic Aneurysm

Benefits of Newer Technique May Outweigh Risks

By Daniel J. DeNoon
WebMD Health News

Reviewed By Louise Chang, MD

Oct. 14, 2009 -- Less invasive endovascular repair of deadly aortic aneurysms is easier on patients and -- at least for two years -- carries no extra risk of death.

Aortic aneurysm -- dangerous ballooning of the body's central artery -- can be fatal if not detected and repaired. They're the 15th leading cause of death in the U.S.

Unfortunately, the operation to repair an aortic aneurysm is dangerous. Indeed, it's one of the surgical procedures that carries the highest death risk.

Open surgery is the standard method for repair. But in the last decade, doctors have developed techniques and tools that let them repair aortic aneurysms using minimally invasive techniques, requiring just small incisions in the groin.

Earlier studies suggested that while this endovascular repair technique avoided some of the complications of open surgery, patients were more likely to die or require a second surgery.

Now Frank A. Lederle, MD, of the Minneapolis VA Medical Center, and colleagues, report early results from their long-term study comparing endovascular to open repair of aortic aneurysms.

The study included 881 veterans eligible for either type of procedure. Half received endovascular repair, and half received open surgery.

The good news: For at least two years, there were not significantly more deaths in the group that underwent the less invasive repair.

Compared to men who underwent open surgery, those who received endovascular repair:

  • Spent less time undergoing the procedure
  • Had far less blood loss and needed no blood transfusions
  • Needed less mechanical ventilation
  • Spent four fewer days in the hospital
  • Spent three fewer days in intensive care

There was a downside. The men who underwent endovascular repair were exposed to more radiation due to prolonged fluoroscopy, and they were exposed to much more contrast agent, which can harm the kidneys.

It's too soon to say the less invasive technique is better, though. Lederle warns that the full study will take another three years to complete. Without longer-term data, it's impossible to fully compare the two approaches.

Lederle and colleagues report their findings in the Oct. 14 issue of The Journal of the American Medical Association.

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SOURCES: Frank A. Lederle, MD, Veterans Affairs Medical Center, Minneapolis, Minn.

Lederle, F.A. The Journal of the American Medical Association, Oct. 14, 2009; vol 302: pp 1535-1542.

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