Endovascular Aneurysm Repair Vs. Open Surgery Survival Rates

An endovascular repair of an abdominal aortic aneurysm isn’t as troubling to consider when compared to the more invasive, open surgical treatment. On the other hand, stented grafts can fail, and this procedure requires lifelong CT scans (radiation) for monitoring.

A Johns Hopkins professor has determined that the four-year survival rate between both repair procedures for abdominal aortic aneurysms is similar.

This means that elderly patients, who might have been considered too frail to undergo the invasive open repair, didn’t fare better with the endovascular version. This is very compelling information for an elderly person who’s afraid to have the open procedure.

No Survival Rate Advantage

For patients over age 70, this study showed that the minimally invasive endovascular grafting did not result in a higher survival rate. The full report appears in the Nov. 22, 2012 issue of The New England Journal of Medicine.

The research “raises a new question of whether older patients should even have their aneurysms repaired,” says study leader Julie A. Freischlag, MD, “because even when they were fixed, it did not prolong life. They are dying of the diseases of old age.”

Dr. Freischlag is the director of the Johns Hopkins University School of Medicine Department of Surgery.

What is an abdominal aortic aneurysm?

An aneurysm is when a portion of a blood vessel wall becomes weak, causing it to swell, dilate or “balloon.” Think of a balloon filling with air; as it enlarges, its “walls” become thinner and more prone to rupturing.

Likewise, an abdominal aortic aneurysm can rupture if it gets big enough, causing fatal internal bleeding. Such a ruptured aneurysm will cause intense abdominal pain. But until it ruptures, it typically stays silent, causing no symptoms. Usually, they are discovered by accident when the patient gets imaged for an unrelated issue.

An ultrasound can easily detect an aneurysm. When my mother was experiencing intense abdominal pain the night after she was discharged from the hospital after being there for quintuple bypass surgery, I took her to the ER.

She was immediately taken to a back room and right away, the doctor wheeled over the ultrasound equipment and said, “I’m checking her aorta” as he ran the transponder over her abdomen. The result was negative.

Cost of Open Surgery vs. Endovascular for Abdominal Aortic Aneurysm

Open surgery costs $5,000 and carries the risks that come with most major operations like infection. Endovascular costs about $35,000, and the patient must have the appropriate anatomy to “land” the graft. As mentioned previously, endovascular repair requires lifelong CT monitoring — every six months — to check for graft shifting.

The Johns Hopkins study involved 881 patients with a mean age of 70.

-10 aneurysm-related deaths occurred in the endovascular group.

-16 occurred in the open surgery group.

-Six aneurysm ruptures occurred in the endovascular group.

-No ruptures occurred in the open surgery group. However, the report points out that the ruptures happened only in the patients who did not get their regular CT follow-up scans.

Dr. Freischlag says that patients must weigh the risk and benefit ratio. She says the endovascular option is “a good way to go” for younger, healthier patients since it’s cheaper, easier and does not require repeated radiation exposure from lifelong CT scans. For older, weaker patients, “repair may not be an option,” she says.

Source: hopkinsmedicine.org/news/media/releases/long_term_survival_rates_after_less_invasive_repair_of_abdominal_aneurysm_the_same_as_with_open_procedure