An open surgery involves a large incision made in the belly to clamp, cut out the bulge, and replace the weakened part of the aorta with a graft, an operation that costs about $5,000. Patients are at risk of long hospital stays, pain and an increased risk of infections, risks associated with most major operations.
With endovascular repair, a tube or stent containing the graft is threaded into an artery through a small incision near the groin, then pushed up into the aorta. Once in the right place, the sheath on the tube is pulled back and the graft pops out to sit inside the aneurysm. The aneurysm isn't cut out, but is contained in a way that defuses the danger of rupture.
This graft costs about $35,000 and only works on patients with the appropriate anatomy to fit the graft. Those who have endoscopic repair must be monitored by CT scans every six months to make sure the graft has not shifted out of place.
For the OVER study, 881 patients ages 49 and older at 42 Veterans Affairs medical centers were randomly assigned to either endovascular repair or open repair beginning in 2003, and were followed for up to nine years. The average age of the patients was 70.
In each group, 146 deaths occurred from all causes. There were 10 aneurysm-related deaths (two within 30 days of surgery and eight later) in the endovascular repair group, and 16 (13 in the first 30 days and three later) in the open repair group. Six aneurysm ruptures were confirmed in the endovascular group; none occurred in the open repair group. The researchers say the ruptures occurred only in patients who did not have regular, recommended CT scans.<
|Contact: Stephanie Desmon|
Johns Hopkins Medicine