A burst aneurysm in the abdominal aorta is a deadly condition. In fact, about half of these patients don't make it to the hospital in time. Those who do more often than not face open surgery to repair the blood vessel. This study finds that a minimally invasive interventional radiology treatment for ruptured aneurysms called endovascular aneurysm repair (EVAR) is safer than open surgical repair and is associated with lower mortality rates, say researchers at the Society of Interventional Radiology's 37th Annual Scientific.
Abdominal aortic aneurysm is a local area of bulge or dilatation in the abdominal aorta. If left untreated, this bulge can increase in size and - after reaching a certain size - can burst or rupture causing fatal internal bleeding. In the United States, nine percent of the population over the age of 65 years has an abdominal aortic aneurysm, and there are 15,000 deaths per year from ruptured abdominal aortic aneurysms. A man is four times more likely to suffer an aneurysm of this kind than a woman, and smokers are also four times as likely to develop the condition.
"People with peripheral arterial disease are at risk of an aneurysm, which is a weakening and abnormal bulging of a major artery. Once this area of bulge ruptures, this can lead to fatal internal hemorrhage," explained Prasoon Mohan, M.D., co-author of the study from the department of diagnostic and interventional radiology at Saint Francis Hospital in Evanston, Illinois. "Prior to the development of minimally invasive endovascular repair, it was customary for individuals to undergo open surgery, but now the majority of these elective aneurysm repairs are being done by endovascular technique. It's only a question now of getting clinicians and institutions to use the same technique in emergency settings for ruptured aneurysms," he added.
"We found that endovascular aortic repair resulted in significantly fewer hospital deaths after treatment compared to open surgery, and the hospital stay associated with endovascular repair was less than that of open surgery," said Mohan.
Once an abdominal aortic aneurysm reaches a particular size, treatment is recommended to prevent its rupture. Open surgery requires a large incision in the abdomen and replacement of the dilated portion of the aorta with a synthetic blood vessel. In endovascular repair, an interventional radiologist makes a small incision in the groin, which serves as an entry point for a thin wire catheter that is guided through the femoral artery to the dilated portion of the aorta using advanced medical imaging. Once in place, a stent graft that is compressed into the catheter is opened up and the edges of the stent push against the aortic wall and stays in place. Blood flows through the stent graft instead of the abnormally dilated aorta and prevents it from rupturing.
The researchers reported that 39.7 percent of patients who received open surgery died in the hospital, compared to 28.2 percent of patients who received EVAR. The average length of hospital stay for people who had EVAR was about 11 days, but those who received open surgery stayed almost 14 days. While 35 percent of patients were able to go home without requiring further in-patient rehabilitation after endovascular repair, only 22 percent of those who received open surgery were discharged to their homes. Interestingly, regardless of the type of repair, women had worse outcomes compared to men after the procedure.
"Endovascular aortic repair involves less recovery time and fewer discharges to in-patient care facilities, potentially saving insurers, institutions and individuals money," he added.