Elderly Patients with Ruptured Aortic Aneurysm
Improve Survival with Least Invasive Repair
Study finds having surgery and mesh stent procedures
available helps all ages survive
June
16, 2008 – Older people, in particular those over age 75, that suffer a
ruptured abdominal aortic aneurysm, have a much better chance of
survival if the repair is performed by a less invasive procedure than
open surgery. But for people of all ages, having two options for the
repair is shown to improve survival, according to a new study.
Most patients with ruptured abdominal aortic
aneurysms—which occur when a segment of the aorta, the large blood
vessel that supplies the pelvis, legs and abdomen, enlarges and
bursts—do not survive long enough to reach the hospital, according to
the report in the June issue of Archives of Surgery, one of the JAMA/Archives
journals.
Among patients who do, most undergo a procedure
known as open graft replacement, in which the aorta is repaired through
an open incision and the damaged segment of the aorta is replaced with a
synthetic graft.
Rates of death following this procedure are
approximately 40 percent to 50 percent and have not changed over the
past four decades, the authors note.
In 1994, endovascular abdominal aortic aneurysm
repair - a minimally invasive procedure in which a mesh stent is
inserted through an artery and positioned within the aorta - was
introduced as a treatment alternative.
Andreas Wibmer, M.D., of the Medical University of
Vienna, Austria, and colleagues conducted an analysis of 89 consecutive
patients treated for abdominal aortic aneurysms at one center between
1999 and 2006. From 1999 through 2003, 42 patients were treated with
open graft replacement. In 2003, the university established a protocol
during which some selected patients (16 patients or 34 percent) were
instead treated with endovascular abdominal aortic aneurysm repair.
The researchers found that the overall death rates
in the 90 days after surgery decreased following the introduction of the
endovascular procedure, from 54.8 percent in the first period to 27.7
percent in the second period.
Improved survival was most apparent in patients
older than 75.5 years. However, the 90-day death rate also decreased for
patients undergoing open graft reduction following the introduction of
endovascular repair, from 54.8 percent to 29 percent.
“Our findings strongly indicate that the
implementation of endovascular abdominal aortic aneurysm repair is able
to reduce the overall mortality in patients with ruptured abdominal
aortic aneurysm,” the authors write.
“By offering both treatment options, it was
possible to improve the immediate and mid-term overall results by
shifting high-risk patients from the open graft reduction to the
endovascular abdominal aortic aneurysm repair group, thereby improving
the results of open surgery.”
“The issue of which subgroup of patients might
benefit the most from this less-invasive technique still remains,” they
continue.
In the study, older patients and those who were
more hemodynamically stable—those whose blood pressure remained
relatively constant—appeared to experience the largest improvements in
survival with this treatment option.
Keep up with the latest news for senior citizens, baby
bommers
June
16, 2008 – Older people, in particular those over age 75, that suffer a
ruptured abdominal aortic aneurysm, have a much better chance of
survival if the repair is performed by a less invasive procedure than
open surgery. But for people of all ages, having two options for the
repair is shown to improve survival, according to a new study.