JAMA: Endovascular repair for AAA may reduce short-term death risk

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Patients who received the less-invasive endovascular repair of an abdominal aortic aneurysm (AAA) had a lower risk of death in the first 30 days after the procedure compared to patients who had an open repair, but both procedures had similar rates of death after two years, according to an Oct. 14 study in the Journal of the American Medical Association.

"Each year in the U.S., 45,000 patients with AAA undergo elective repair, resulting in more than 1,400 peri-operative [the first 30 days after surgery or inpatient status] deaths," according to the authors. However, “limited data are available to assess whether endovascular repair of AAA improves short-term outcomes compared with traditional open repair," the authors wrote.

Frank A. Lederle, MD, of the Veterans Affairs Medical Center in Minneapolis, and colleagues are conducting a multicenter clinical trial to examine outcomes after elective endovascular and open repair of AAA. This is an ongoing nine-year trial, with this interim report including postoperative outcomes of up to two years for 881 patients (age 49 years or older).

Researchers randomized patients to either endovascular (444 patients) or open (437 patients) repair of AAA. The average follow up was 1.8 years.

The investigators found that the rate of death after surgery was significantly higher for open repair at 30 days (0.2 vs. 2.3 percent), and at 30 days or during hospitalization (0.5 vs. 3 percent). Yet, they wrote that there was no significant difference in all-cause death at two years (7 vs. 9.8 percent), and death after the peri-operative period was similar in the two groups (6.1 percent vs. 6.6 percent).

According to the authors, patients in the endovascular repair group had reduced procedure time, blood loss and duration of mechanical ventilation. "Hospital and ICU stays were shorter with endovascular repair and need for transfusion was decreased. No significant differences were observed in major morbidities, secondary procedures, or aneurysm-related hospitalizations," they wrote.

"Longer-term data are needed to fully assess the relative merits of the two procedures," Lederle and colleagues concluded.