EVAR vs Surgery Study Shows Improved Aneurysm-related Survival

In short

According to a new report featured on heartwire (theheart.org), ruptured abdominal aortic aneurysms (AAAs) repaired using endovascular techniques may save more lives than surgical repair. So says a new Irish analysis, which claims that at 30 days, aneurysm-related survival was 70% for patients treated with endovascular aortic repair (EVAR) compared with 33% for patients who underwent open surgical repair.

Background

The 2013 International Symposium on Endovascular Therapy (ISET) has seen the presentation of data on 568 AAAs operated on at University College Hospital in Galway, a tertiary referral center that takes patients from Donegal in the north of Ireland to patients from the south in Cork. Patients were referred to the hospital if they had a leaking or ruptured AAA, which was defined as blood outside the aortic artery.

As noted, there was a statistically significant improvement in aneurysm-related survival among the patients treated with EVAR. There was no significant difference in the rate of all-cause mortality however. Aneurysm-related mortality was 12.5% in the first week after treatment, 25% at one month, 37.5% at six months, 50% at one year, and 90% at five years. Despite the similar rates of death at five years between the groups, EVAR is associated with a shorter hospital length of stay, fewer interventions and complications, less pneumonia, and fewer blood transfusions.

Investigator comments

“Until 2005, almost 85% of patients with ruptured abdominal aortic aneurysms were treated with open surgical repair, and only a handful received endovascular repair,” lead investigator Dr Sherif Sultan (University College Hospital, Galway, Ireland) told heartwire. “From 2005 onward, we started to do the endovascular intervention. At the same time, we had a very active screening program for AAA and we had a very low threshold for intervention.”

“Regardless of the intervention, whether you have done an endovascular repair or an open repair, it’s still palliative,” said Sultan. “Almost 85% of these patients are dead within five years, even if they are 55 years of age. They don’t survive. If we know that what we do is palliative, then we don’t have patients in the intensive care unit, ending up on renal dialysis, and developing compartmental syndrome and bowel ischemia because we have opened them.”

“Basically, they do a lot better in the short amount of time that they are going to live,” said Sultan. “They have a better quality of life.”

Source: Heartwire (theheart.org), full article here