Less invasive surgery for abdominal aneurysm don't lead to better survival rates

DESPITE earlier signs that a less-invasive surgery is safer and better than “open” operations to repair potentially lethal abdominal aortic aneurysms, a study led by a Johns Hopkins professor shows survival rates after four years are similar for both procedures.

In an extended follow-up of patients in the OVER (Open Versus Endovascular Repair) Trial, researchers found that, contrary to expectations, the two procedures carried about the same long-time survival after four years, even though survival was higher in the endovascular group at the two-year mark. Moreover, among elderly patients often considered too weak to undergo traditional blood vessel repairs, results showed they did not do better with an operation that avoids fully opening the abdomen.

Instead, the OVER trial showed that the minimally invasive operation did not result in increased survival in patients 70 years and older, with benefits confined mainly to those who are younger, according to Julie A. Freischlag, M.D., director of the Department of Surgery at the Johns Hopkins University School of Medicine and leader of the national trial.

A report on the study, which followed patients for up to nine years, appeared in the Nov. 22 issue of The New England Journal of Medicine.

“Overall, the results suggest that the outcomes following endovascular repair continue to improve and the procedure is now an acceptable alternative to open repair, even when judged in terms of long-term survival,” said Dr Freischlag, a professor of surgery at Johns Hopkins and a vascular surgeon at the Baltimore VA Medical Center, one of the sites where the study was conducted. “But this research raises a new question of whether older patients should even have their aneurysms repaired, because even when they were fixed, it did not prolong life. They are dying of the diseases of old age.”

Abdominal aortic aneurysms occur when the wall of the body’s biggest blood vessel, at its location in the abdomen, balloons. If an aneurysm ruptures, severe bleeding is often quickly lethal, so when a dilated vessel over two inches is discovered, surgeons often try to repair it. Abdominal aortic aneurysm is the 14th-leading cause of death for the 60- to 85-year-old age group in the United States.

An open surgery involves a large incision made in the belly to clamp, cut out the bulge, and replace the weakened part of the aorta with a graft, an operation that costs about $5,000. Patients are at risk of long hospital stays, pain and an increased risk of infections, risks associated with most major operations.

With endovascular repair, a tube or stent containing the graft is threaded into an artery tNike Air Penny 2