UW Health Surgeon: Noninvasive Surgery OK for Aortic Aneurysm Patients
Madison, Wisconsin - Patients who have the non-invasive procedure for repairing aortic aneurysms can now be assured that the procedure is safer, and at least as durable, as traditional surgery.
"Endovascular aneurysm repair is now the most common method used in the United States, but surgeons have been waiting for the results of two large clinical trials to guide us on how patients fare over the long term," says Dr. K. Craig Kent, chair of surgery at University of Wisconsin Hospital and Clinics. "The results of these studies suggest the popularity of this surgery will continue to grow."
Writing the lead editorial in the May 20 New England Journal of Medicine (NEJM), Kent concludes that two European clinical trials show patients fare much better in the short term with non-invasive or endovascular techniques. And, at eight years out, the mortality rate is equal to that of open surgery.
A ruptured aortic aneurysm is a dire medical emergency - it kills 85 percent of the time. The solution is for surgeons to find and repair aneurysms before they rupture. In the United States, surgeons repair about 40,000 aneurysms a year, about 60 percent of the time using endovascular techniques.
The results of two European trials, the Dutch Randomized Endovascular Aneurysm Repair (DREAM) trial and the Endovascular Aneurysm Repair (EVAR-1) trial from the United Kingdom, are also reported in the NEJM's May 20 edition. A month after surgery, patients who had the endovascular procedure were three to four times more likely to survive than those who had open surgery.
"Patients who have endovascular procedures fare much better in the first month after their procedure, both in terms of survival and complications, such as heart attacks as well as problems of the kidneys and the lungs," says Dr. Kent, who also is chair of the Department of Surgery at the UW School of Medicine and Public Health. "In a longer view, at eight years, the survival rates are equal."
Endovascular fixes may not be as durable. Indeed, one of the studies showed that endovascular aneurysm repairs needed to be redone about 30 percent of the time. (However, the majority of these re-interventions involved relatively minor procedures.) This compares to a re-intervention rate of about 20 percent in aneurysms that are repaired with open surgery.
Because endovascular surgery has a significant advantage in the short term, and because long-term survival rates are the same, Kent expects that more surgeons and patients will opt for the non-invasive techniques. Currently, endovascular repairs account for more than 60 percent of aneurysm surgeries in the United States.
The exception may be for patients who are younger and healthier, and thus expected to have longer life spans. Because the endovascular surgeries need to be redone more often, some of these patients might opt for the surgical fix.
"It is wonderful that we now have data showing that these newer techniques are safe and effective," Kent says. "However, the studies also point to the need for careful monitoring of patients who receive endovascular repairs because in some cases, reinvention will be necessary."
Date Published: 05/19/2010