Using a less invasive method to treat aortic aneurysms in the abdomen is not always preferable to more traditional surgery in which the abdomen is cut open, according to a new study by the chief of vascular surgery at Loyola University Medical Center.
An abdominal aortic aneurysm occurs when a blood vessel in the aortic artery, which runs from the heart to the pelvis, ruptures, leading to internal bleeding that can damage organs. The aortic artery supplies nearly the entire body with blood. Smoking, high blood pressure, high cholesterol, male gender, emphysema, genetic factors and obesity increase the risk of developing an aortic aneurysm.
In recent years, surgeons have been using a less invasive technique known as the endovascular method to treat aortic aneurysms in the abdomen. This technique calls for the surgeon to insert a catheter in an artery in the groin that would then be guided to the ruptured blood vessel. The catheter drains the blood from the abdomen.
The main finding of the new study about the endovascular method is "that we shouldn't be jumping on the bandwagon" and treat every patient with the endovascular method, said Dr. Jae S. Cho, Loyola's chief of vascular surgery and endovascular therapy. "This is because not everyone has an anatomy amenable to endovascular repair. An abdominal aortic aneurysm is a highly lethal problem. It may not be conducive to endovascular repair."
The study, which was published in the Journal of Vascular Therapy, looked at patients treated between January 2001 and November 2011 at the University of Pittsburgh Medical Center. Cho worked at the university before he moved to Loyola.
"The endovascular treatment is less invasive. Your intuition tells you that an operation with two small incisions is better," Cho said. But the endovascular treatment may lead to more internal bleeding, Cho said.
"My conclusion is that endovascular repair does not seem to conclusively offer survival benefits over open surgery, and that wide adoption and routine application of endovascular treatment should be deferred until we have good evidence. We wanted to compare if there was any difference, and that was what we did," he said.
Of patients with abdominal aortic aneurysms, researchers compared 241 treated with open surgery and 37 who had endovascular surgery. The open surgery group averaged an age of 75.6 years, while the other one averaged 74.9 years. The odds of survival were 54 percent after the first year, and 47 percent after three years for the open surgery group, and 50 percent after the first year and 42 percent after three years for those who underwent endovascular treatment.
Another challenge posed by the endovascular technique is that hospitals must be prepared to offer it at any time, Cho said. "A given institution has to be equipped for the technique at all hours of the day or night. Technicians and staff have to be available," he said.
One limitation of the study, which is a retrospective review of patients' outcomes, is that it reviewed the results of patients who had already been treated for aortic aneurysms, said Dr. Navyash Gupta, chief of the division of vascular surgery at NorthShore University HealthSystem.
"I think, overall, it's a good study ... but that it has limitations. ... The retrospective review has selection and treatment bias," Gupta said. The selection bias can involve selecting patients who would be unable to survive open surgery, and instead, treating them with the endovascular approach, he said.Copyright © 2015, Los Angeles Times