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Study suggests 30-day survival benefit from endovascular surgery for treatment of aortic aneurysm

August 25, 2004

Early results of a UK study published online today by THE LANCET (Wednesday 25 August 2004) suggest that a surgical procedure to repair aortic aneurysm that is less invasive than conventional open surgery could reduce death within a month of surgery by around two-thirds.

Abdominal Aortic Aneurysm (AAA) is a dangerous swelling of the abdominal aorta which has an increased chance of rupture if it is larger than 5"¢5cm-a majority of people die from ruptures. The cause of AAA is complex, including atherosclerosis,smoking, and a genetic predisposition.

Surgeons have perfected a new method for treating AAA's over the past decade, called endovascular repair, or EVAR. In this procedure, 2 small incisions are made in the groin, and a graft is passed through the arteries under Xray control and fixed with a stent which holds the graft in place; this procedure is much less invasive than conventional surgery which requires a deep abdominal incision.

41 UK hospitals collaborated in the study, providing a surgical and radiological team to investigate whether EVAR is as good or better than conventional open surgery. More than 1000 patients with large (5"¢5 cm or greater) AAA (all of whom were over 60 years of age, and over 90% of whom were men) were randomly allocated to receive either EVAR or conventional open surgery. The death rate within 30 days of surgery was reduced by around two-thirds compared with patients given open surgery (1"¢7% and 4"¢7% mortality rates, respectively); however, there were 75% more secondary procedures done among patients initially given EVAR.

Investigator Roger Greenhalgh (Imperial College London, and Hammersmith Hospitals NHS Trust, UK) comments: "These early results with EVAR, applied to large aneurysms in suitable patients, provide justification for continued use of this technique in controlled or trial settings; however, the early promise of endovascular repair cannot be guaranteed and might not endure in the long term. These 30-day mortality results are a licence to continue scientific evaluation of EVAR, but not to change clinical practice. He adds: "The NHS is the perfect vehicle to do research of this type, but it is entirely dependent on the determination of a group of doctors-as in this case-to overcome clinical uncertainty to be able to offer their patients the best possible treatment."



Lancet