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Less-invasive aneurysm fix not best in long run

By Times Staff Writer
Published June 9, 2005

A promising technique for fixing dangerous bulges in the biggest abdominal artery saves more lives than open surgery initially, but not over the long term, researchers found.

While the results were disappointing, they could help patients deciding between the two options.

In a technique called endovascular repair, a cloth patch is threaded up an artery from the groin to cover the bulge, or aneurysm, in the abdominal aorta, which carries blood from the heart to the lower body. A stent holds the patch in place.

Last fall, Dutch researchers said the approach reduced patients' risk of dying within a month of surgery by about three-fourths, compared with cutting open the abdomen and sewing in a patch.

In today's New England Journal of Medicine, the Dutch group says after nearly two years spent following 350 patients, about 90 percent were still alive in both groups.

The frailest patients were more likely to die soon after the open surgery, but very sick patients surviving the endovascular procedure were more likely to die over the next two years, said Dr. Jan D. Blankensteijn, lead researcher.

Blankensteijn and Dr. Peter J. Pappas, director of vascular surgery at New Jersey Medical School in Newark, said patients likely to live another decade or more should opt for the open surgery.

A ruptured aneurysm kills about 80 percent of patients, so if the bulge is big enough, surgeons repair it.

A growing number of patients are now demanding the endovascular procedure, Pappas said, despite evidence that open surgery is better in the long term. He said that over years, the endovascular grafts can slip out of place, leak or be punctured by the metal stent.

[Last modified June 9, 2005, 01:18:46]