Navigation Links
Study questions technique to repair ruptured abdominal aortic aneurysms

MAYWOOD, Ill. - A new study raises a cautionary note about the increasing use of a minimally invasive procedure to repair ruptured abdominal aortic aneurysms, according to vascular surgeon Dr. Jae Sung Cho of Loyola University Medical Center.

A ruptured abdominal aortic aneurysm (AAA) causes massive internal bleeding that requires immediate emergency surgery to save the patient.

The rupture can be repaired either with an open surgery or with a newer, less-invasive endovascular technique that involves the use of a catheter.

At first glance, the endovascular technique would appear to be a better option because it is minimally invasive and has lower complication rates. It's being increasingly used to repair ruptured AAAs.

But a study in the Journal of Vascular Surgery, published online ahead of print, found that the endovascular technique does not conclusively improve survival.

In the retrospective study, Cho and colleagues compared 37 patients with ruptured AAAs who underwent emergency endovascular surgery and 241 patients with ruptured AAAs who underwent open surgery. The groups were matched by sex, age, surgeon experience, patient condition and other factors. The average age was 74.9 in the endovascular group and 75.6 in the open surgery group.

The endovascular group's probability of survival was 50 percent after the first year and 42 percent after three years. By comparison, the open surgery group's probability of surviving was 54 percent after the first year and 47 percent after three years.

The overall complication rate was 66 percent in the open surgery group and 54 percent in the endovascular surgery group, but this difference was not statistically significant.

Cho and colleagues wrote that preferential use of the endovascular technique "should be deferred until results of prospective, randomized trials are available and predictive factors for its success are identified. Some patients may be harmed by indiscriminate insistence on (the endovascular technique)."

The study was conducted at the University of Pittsburgh Medical Center, where Cho practiced before recently joining Loyola as chief of vascular surgery. Cho is a professor in the Department of Surgery, Division of Vascular Surgery and Endovascular Therapy at Loyola University Chicago Stritch School of Medicine.

An AAA is a bulge in the large blood vessel that supplies blood to the abdomen and legs. Risk factors for AAAs include smoking, high blood pressure, high cholesterol, male gender, emphysema, genetic factors, obesity and increasing age. The bulge typically develops slowly over many years. The larger the aneurysm, the more likely it is to rupture and cause massive bleeding. About 15,000 people per year die from ruptured AAAs. Many die before getting to the hospital. But certain patients can be saved if they make it to the hospital on time.

In the open surgery technique, the surgeon makes a large incision and opens up the abdomen. The surgeon clamps the aorta to stop the bleeding, then replaces or bypasses the ruptured section with an artificial blood vessel.

In the endovascular technique, the surgeon inserts a catheter in a groin artery and guides the catheter through blood vessels to the site of the burst aneurysm. The surgeon deploys a device called a stent graft. The device, shaped like an inverted Y, is made of GoreTex or Dacron, and is supported by metal webbing. After it is deployed from the catheter, the stent graft expands outward to the walls of the artery. This allows blood to flow safely through the stent graft, rather than gushing into the abdominal cavity.

While much less invasive than open surgery, the endovascular technique has drawbacks, Cho said. There can be more internal bleeding because of a delay in clamping the aorta. And even after a successful stent graft placement, there may be ongoing blood loss. Also, the large amount of blood left in the abdomen can compress other organs and the chest cavity and may require surgery to remove the blood.

The endovascular technique also can put a significant strain on hospital resources. The hospital must stock various sizes of stent grafts, which cost at least $12,000 each. And skilled endovascular, radiologic and nursing teams must be available around the clock.

"It is not pragmatic to undertake such systemic and systematic changes in the absence of clear evidence of (the endovascular technique's) superiority," Cho and colleagues wrote.

Contact: Jim Ritter
Loyola University Health System

Related medicine news :

1. Stopping Controversial Asthma Drugs Could Have Downside: Study
2. Divorced parents in hostile relationships use technology to sabotage communication, MU study finds
3. Working moms spend less time daily on kids diet, exercise, study finds
4. You Can Learn While You Sleep, Study Suggests
5. Excess Pounds Raise Risk of Breast Cancer Recurrence, Death: Study
6. Study explores injury risk in military Humvee crashes
7. Electronic Cigarettes Have Slight Impact on Heart: Study
8. The ACCESS-EU study
9. The ORIGIN-GRACE study
10. People of normal weight with belly fat at highest death risk, Mayo Clinic study
11. New Blood Thinner Effient No Better Than Plavix at Preventing Heart Trouble: Study
Post Your Comments:
(Date:10/13/2017)... ... October 13, 2017 , ... Southern ... and Jennifer Huggins, PharmD ’17, along with clinical associate professor Janice Frueh, ... cardiovascular diseases during the 15th Annual Women’s Health Conference. The SIU School ...
(Date:10/13/2017)... ... October 13, 2017 , ... Ellevate Network, the leading network for professional ... action towards gender equality at their inaugural Summit in New York City in June. ... a social audience of over 3 million. To watch the Mobilize Women video, ...
(Date:10/13/2017)... ... October 13, 2017 , ... “The Journey: From the Mountains to the Mission ... lost souls in the Philippines. “The Journey: From the Mountains to the Mission Field” ... the Bible. She has taught all ages and currently teaches a class of ladies ...
(Date:10/12/2017)... ... October 12, 2017 , ... The company has developed ... consumer and regulatory authorities worldwide. From Children’s to Adults 50+, every formula has ... highest standard. , These products are also: Gluten Free, Non-GMO, Vegan, Soy ...
(Date:10/12/2017)... ... October 12, 2017 , ... ... Restoration, has recently contributed a medical article to the newly revamped Cosmetic ... Mohebi’s article spotlights the hair transplant procedure known as Follicular Unit Extraction ...
Breaking Medicine News(10 mins):
(Date:10/10/2017)...   West Pharmaceutical Services, Inc. (NYSE: WST), ... administration, today shared the results of a study highlighting ... intradermal administration of polio vaccines. The study results were ... 2017 by Dr. Ondrej Mach , Clinical Trials ... (WHO), and recently published in the journal Vaccine. ...
(Date:10/4/2017)... Mass. , Oct. 4, 2017 ... of single-use, self-contained, illuminating medical devices, today announced ... National Health Surveillance Agency (or Agência Nacional de ... The first single-use, cordless surgical retractor with integrated ... provides optimal access, illumination and exposure of a ...
(Date:10/2/2017)... The Rebound mobile app is poised to become a vital ... prescription drug addiction. The app empowers users to develop an ... their dosage in a safe, controlled manner while maximizing well-being. ... 100,000 people to sign up will enjoy 3 months of ... ...
Breaking Medicine Technology: