Endovascular aneurysm procedure as effective as open surgery, study finds

May 29, 2019

WINSTON-SALEM, N.C. - May 30, 2019 - A minimally invasive procedure to repair abdominal aneurysms thought to be less effective than traditional open surgery has been shown to perform as well as the open repair and be as long-lasting.

Findings published in the May 30 issue of the New England Journal of Medicine showed that long-term overall survival was similar among patients who underwent endovascular repair and those who underwent open repair.

"This should be good news for patients because the endovascular procedure is less painful and has a much shorter recovery period than the open procedure, though it is more expensive," said the study's principal investigator, Julie Ann Freischlag, M.D., chief executive officer of Wake Forest Baptist Health, dean of Wake Forest School of Medicine and professor of vascular and endovascular surgery.

"Earlier studies conducted more than a decade ago in Europe had indicated long-term problems with the endograft used in the less invasive procedure. As a result, it isn't readily available for everyone in Europe and other parts of the world," Freischlag said. "Hopefully our study will dispel some of the concerns from the earlier studies and provide the scientific evidence to warrant a second look by the medical community."

An endograft is a tiny tube or stent that is surrounded by mesh-impregnated fabric to reinforce the weak spots in the abdominal aorta. It is inserted through small groin incisions using imaging to guide the graft into place. When permanently placed inside the aorta, it alleviates blood pressure by allowing blood to flow without pushing on the weakened, bulging artery.

In open surgery, the physician makes a large incision in the belly or side of the abdomen and uses a man-made, tube-like graft that is sewn into place to replace the weak and bulging section of the aorta in the belly.

In the study that began in 2002, 881 patients with asymptomatic abdominal aortic aneurysms were randomized to either endovascular repair or open repair groups. All of the participants were patients at 42 Veterans Health Administration hospitals in the United States and candidates for either procedure. Following the respective procedures, patients were followed for 14 years.

During the first four years of follow-up, overall survival appeared to be higher in the endovascular-repair group than in the open-repair group. But in years four through eight, overall survival was slightly higher in the open-repair group. After eight years, overall survival was once again higher in the endovascular group. According to the study authors, none of those trends were statistically significant.

The principal finding was that no significant difference was observed between the endovascular and the open-repair groups in the primary outcome of long-term all-cause mortality. Among younger patients, endovascular repair resulted in somewhat higher long-term survival than open repair, but among older patients, endovascular repair resulted in somewhat lower long-term overall survival than open repair. More deaths from chronic obstructive lung disease occurred in the open-repair group than in the endovascular group, but the research team could not determine a reason.

"So for younger patients or for those who had extensive heart disease, the endovascular procedure was somewhat better," Freischlag said. "Open surgery was a better option for older patients, which was just the opposite of what we expected."
Support for the trial was provided by the Cooperative Studies Program of the Department of Veterans Affairs Office of Research and Development.

Freischlag said the entire study team is grateful to all the veterans who chose to volunteer to participate in the study.

Co-authors include: Frank A. Lederle, M.D., (deceased), Veterans Affairs (Va) Medical Center, Minneapolis; Tassos C. Kyriakides, Ph.D., and Gary R. Johnson, M.S., VA Medical Center, West Haven, Conn.; Kevin T. Stroupe, Ph.D., and Zhiping Huo, M.S , VA Medical Center, Heines, Ill.; Frank T. Padberg, Jr., M.D., VA Medical Center, East Orange, N.J.; and Jon S. Matsumura, M.D., VA Medical Center Madison, Wis..


Wake Forest Baptist Medical Center

Related Aorta Articles from Brightsurf:

Broccoli and Brussels sprouts a cut above for blood vessel health
New research from Edith Cowan University has shown some of our least favourite vegetables could be the most beneficial when it comes to preventing advanced blood vessel disease.

Examining enlargement of the aorta among older endurance athletes
Researchers in this observational study evaluated dimensions of the aorta in 442 older competitive runners and rowers (ages 50 to 75) to examine the association between long-term endurance exercise and enlargement of the artery.

Study finds long-term endurance exercise is associated with enlarged aorta
Study finds high percentage of long term endurance athletes had aortas larger than the upper limit of clinical normality.

McGill researchers lay foundation for next generation aortic grafts
A new study by researchers at McGill University has measured the dynamic physical properties of the human aorta, laying the foundation for the development of grafts capable of mimicking the native behavior of the human body's largest artery.

Endovascular aneurysm procedure as effective as open surgery, study finds
A minimally invasive procedure to repair abdominal aneurysms thought to be less effective than traditional open surgery has been shown to perform as well as the open repair and be as long-lasting.

Thrombospondin-1 as a potential therapeutic target for Thoracic Aortic Aneurysms
Researchers centered at the University of Tsukuba and Kansai Medical University in Japan reveal matricellular protein Thrombospondin-1 (Thbs1) contributes to the development of aortic aneurysm in mice and humans.This study reveals that Thbs1 is not only a critical component of mechanotransduction, but also a modulator of elastic fiber organization and actin cytoskeletal remodeling.

Better physical fitness and lower aortic stiffness key to slower brain aging
The rate of decline in certain aspects of memory may be explained by a combination of overall physical fitness and the stiffness of the central arteries, researchers from Swinburne's Centre for Human Psychopharmacology have found.

D-Transposition of the great arteries: a new era in cardiology
In the current issue of Cardiovascular Innovations and Applications (Volume 3, Number 1, 2018, pp. pp.

CT shows enlarged aortas in former pro football players
Former National Football League (NFL) players are more likely to have enlarged aortas, a condition that may put them at higher risk of aneurysms, according to a study being presented today at the annual meeting of the Radiological Society of North America (RSNA).

Abdominal aortic aneurysm linked to dysregulated tryptophan metabolism, study finds
Researchers have found a link between dysregulated tryptophan metabolism and abdominal aortic aneurysm, a life-threatening vascular disease, according to a new study led by Georgia State University.

Read More: Aorta News and Aorta Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.