A promising technique for fixing dangerous bulges in the biggest abdominal artery saves more lives than open surgery initially, but not over the long term, researchers found.
While the results were disappointing, they could help patients deciding between the two options.
In a technique called endovascular repair, a cloth patch is threaded up an artery from the groin to cover the bulge, or aneurysm, in the abdominal aorta, which carries blood from the heart to the lower body. A spring-like device called a stent holds the patch in place.
Last fall, Dutch researchers reported that the approach reduced patients’ chances of dying within a month of surgery by about three-fourths, compared with cutting open the abdomen and sewing in a patch. A larger British study had similar findings.
In Thursday’s New England Journal of Medicine, the Dutch group reported that after nearly two years spent following 350 patients, about 90 percent were still alive in both groups.
The frailest patients were more likely to die soon after the open surgery, but very sick patients surviving the endovascular procedure were more likely to die over the next two years, said lead researcher Dr. Jan D. Blankensteijn, chief of vascular surgery at Radboud University Nijmegen Medical Centre in the Netherlands.
“For high-risk patients, endovascular repair is clearly the way to go,” said Dr. Peter J. Pappas, director of vascular surgery at New Jersey Medical School in Newark.
Pappas and Blankensteijn said relatively healthy patients likely to live another decade or more should opt for the open surgery.
A ruptured aneurysm kills about 80 percent of patients, often within minutes, so if the bulge is big enough, surgeons repair it. About 40,000 procedures are done in this country each year.
A growing number of patients are now demanding the endovascular procedure, believing it is best, Pappas said, despite the suspicions of many vascular surgeons that open surgery is better in the long term. He said that over years, the endovascular grafts can slip out of place, leak or be punctured by the metal stent.
The results of a few years’ follow-up from the British study, expected within weeks, could disprove that.
Better grafts now in development may improve survival, Pappas added.
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On the Net: http://www.nejm.org
Society for Vascular Surgery: http://svs.vascularweb.org
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