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2nd Option Improves Abdominal Aorta Repair Outcomes

Less invasive treatment using stent cut overall mortality almost in half, study finds

TUESDAY, June 17 (HealthDay News)-- Having two options for repair of ruptured abdominal aneurysms has led to improved post-surgery survival for patients, says a study by researchers at the Medical University of Vienna in Austria.

Ruptured abdominal aneurysms occur when the aorta -- the large blood vessel that supplies blood to the pelvis, legs and abdomen -- enlarges and bursts. In most cases, people don't survive long enough to reach a hospital.

Most patients who do make it to a hospital undergo a procedure called open graft replacement. In this surgery, done through an open incision, the damaged segment of the aorta is replaced with a synthetic graft. Post-surgery death rates are 40 percent to 50 percent and haven't changed over the past four decades, according to background information in the study.

A minimally invasive procedure called endovascular abdominal aortic aneurysm repair was introduced in 1994. A mesh stent is inserted through the artery and positioned within the aorta.

In this study, the researchers compared patients who had open graft replacement and 16 who had endovascular abdominal aortic aneurysm repair, which was introduced at the Medical University of Vienna in 2003.

Following the introduction of the endovascular procedure, the overall patient death rate in the 90 days after surgery decreased from 54.8 percent to 27.7 percent. Improved survival was most apparent in patients older than 75.5 years.

Interestingly, the death rate for patients who had open graft replacement declined from 54.8 percent to 29 percent after the introduction of the endovascular procedure.

"Our findings strongly indicate that the implementation of endovascular abdominal aortic aneurysm repair is able to reduce the overall mortality in patients with ruptured abdominal aortic aneurysm," the study authors wrote.

"By offering both treatment options, it was possible to improve the immediate and mid-term overall results by shifting high-risk patients from the open graft reduction to the endovascular abdominal aortic aneurysm repair group, thereby improving the results of open surgery."

The study was published in the June issue of the journal Archives of Surgery.

More information

The American Academy of Family Physicians has more about abdominal aortic aneurysm.

-- Robert Preidt

SOURCE: JAMA/Archives journals, news release, June 16, 2008

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