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Minimally Invasive Surgery Fixes Aneurysms
Date:1/30/2008

Study finds advantages over conventional operation

WEDNESDAY, Jan. 30 (HealthDay News) -- An operation using tiny incisions to repair a potentially fatal weakness of a major heart artery has a lower death rate and better overall results than conventional surgery, according to a major new study.

"There have been a couple of randomized trials in Europe, both of which showed perioperative benefits with EVAR [endovascular aneurysm repair]," said study author Dr. Marc L. Schermerhorn, an assistant professor of surgery at Beth Israel Deaconess Medical Center in Boston. "In terms of early results, our study certainly confirmed the results of the randomized trials. We prove that those results are transferable to the U.S. Medicare population."

"Perioperative" refers to the period immediately after a procedure to repair a bulge in the abdominal aorta, the body's largest heart vessel. With conventional surgery, the weak spot is patched through a large incision in the abdomen. With endovascular repair, the weak spot is strengthened by a patch or tube threaded upward from small incisions in the groin.

The new study compiled results of 22,830 such procedures, half conventional surgery, half EVAR, in Medicare recipients. As did the earlier studies, it showed a marked difference in death rates immediately after the procedure, with the difference widening with age. For example, just 0.4 percent of people aged 67 to 69 having EVAR died following the procedure, compared to 2.5 percent of those having conventional surgery. The comparable rates for people aged 85 and older were 2.7 percent for those having EVAR, and 11.2 percent for those having conventional surgery.

The difference in death rates narrowed in the year that followed the procedures, disappearing in the fourth year after the procedure.

EVAR offers other immediate advantages, such as a shorter hospital stay -- an average of three days versus nine days f
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