Endovascular AAA Repair Is Gaining, Expert Asserts

By Timothy F. Kirn
Elsevier Global Medical News

LAS VEGAS -- The percentage of patients with an abdominal aortic aneurysm deemed appropriate for endovascular grafting repair will grow in the future. In fact, it may already have, Timothy M. Sullivan, M.D., predicted at a meeting on vascular interventions sponsored by Medical Media Communications.

"I think the data are currently available to support more aggressive use of endovascular repair," said Dr. Sullivan, of the division of vascular surgery at the Mayo Clinic, Rochester, Minn., in a talk on hot topics and hot trials. "I think more and more patients will be well treated with endovascular repair."

Dr. Sullivan

Currently about 50% of individuals with an abdominal aortic aneurysm (AAA)needing repair are considered candidates for an endovascular grafting procedure. But it should not be just high-risk surgical patients who are considered, Dr. Sullivan said. The question to date has been the long-term complication rate of endovascular grafting, and two recent studies are pertinent. Both trials had comparable results, in that both reported that in-hospital mortality and complications were less with endovascular grafting compared with open repair procedures, and then over time the mortality rates of the patients randomized to endovascular grafting caught up.

The Dutch Randomized Endovascular Aneurysm Management trial reported that at 2 years following the procedure, the cumulative survival rate was similar for both endovascular grafting and open procedure patients at 89%, as was the rate of survival free of moderate and severe complications at 66% (N. Engl. J. Med. 2005;352:2398-405).

Most of the later mortality occurring among the patients who received an endovascular graft was not related to their aneurysms, Dr. Sullivan noted.

The other trial, the EVAR trial, which followed patients longer, out to 4 years, reported that although overall mortality was the same, and the complication rate was much higher, aneurysm-related mortality was 3% lower with endovascular grafting than with open procedure (Lancet 2005;365:2179-86).

Patients do need to be followed after endovascular repair to check for leaks, the most common, important complication, Dr. Sullivan said. But, follow-up is easy to do with CT scanning, and most leaks tend to be simple fixes.

"Typically the fix is relatively easy, and does not necessitate open procedure," he said.