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Minimally Invasive Repair of Ruptured Aortic Aneurysm Could Save More Lives than Surgery
Date:1/18/2010

VAR-suitable by independent reviewers, meaning that the anatomy of the blood vessels used to access the aneurysm, as well as the aneurysm itself, were favorable for the procedure. Four percent of patients died during the EVAR procedure, compared to six percent during open surgery. After six months, 28 percent of the EVAR patients and 55 percent of the open surgery patients had died, a 27 percent reduction in mortality for EVAR compared to open surgery, which was statistically significant. The hospital stay for open surgery patients averaged 17 days, compared to an average of eight days for EVAR patients.

“Although studies have shown EVAR can be used in an emergency situation, this is the first to compare EVAR and open surgery on a level playing field because all of the patients were deemed EVAR-suitable,” Jantje Ten Bosch, M.D., a surgery resident at Atrium Medical Center, Heerlen, Netherlands, who is presenting the study at ISET. “This data strongly suggest that EVAR is a valuable treatment option in EVAR-suitable patients with a ruptured AAA.”

Simple Blood Test Can Identify Leaks

EVAR is far less invasive than open surgical repair of AAA, but a downside is that one in 10 such repairs leak (called an endoleak) potentially needing further repair. To monitor for endoleaks, patients undergo CT scans at three, six and 12 months after the EVAR procedure and yearly after that. CT scans are costly and involve high doses of radiation as well as the use of a contrast dye, which can damage the kidneys. Preliminary research suggests a simple blood test may be able to detect when such a leak is occurring, potentially preventing up to 90 percent of follow-up CT scans.

Researchers found that higher concentrations of a blood protein called matrix metalloproteinase-9 (MMP-9) accurately predicted which patients had an endoleak. The study included 37 patients, 17 consecutive patients who had an endoleak matched with 20 wh
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