Endovascular repair tied to lower operative mortality than open repair; long-term mortality similar
MONDAY, April 12 (HealthDay News) -- In patients with abdominal aortic aneurysm, endovascular repair is associated with significantly lower operative mortality than open surgical repair. In the long term, however, there are no significant differences in total mortality or aneurysm-related mortality, and endovascular repair is associated with complications resulting in higher costs, according to a study published online April 11 in the New England Journal of Medicine to coincide with a presentation at the Charing Cross International Symposium, held from April 10 to 13 in London.
Between 1999 and 2004, Roger M. Greenhalgh, M.D., of the Imperial College in London, and colleagues randomly assigned 1,252 patients with large abdominal aortic aneurysms (at least 5.5 cm in diameter) to undergo either endovascular or open repair, and followed them until the end of 2009.
The researchers found that 30-day operative mortality was significantly lower in the endovascular-repair group than in the open-repair group (1.8 versus 4.3 percent). They found that the endovascular-repair group had an early benefit regarding aneurysm-related mortality but that this benefit was lost by the end of study, at least partly because of fatal endograft ruptures (adjusted hazard ratio, 0.92). At the end of the study, the researchers found that there were no significant group differences in the rate of death from any cause (adjusted hazard ratio, 1.03), and that endovascular repair was associated with higher rates of graft-related complications, reinterventions, and new complications that resulted in higher overall costs.
"These findings have implications for the selection of patients for endovascular repair, the choices for patients, surveillance after repair, and cost-effectiveness," the authors write. "The results also confirm that careful long-term follow-up of surgical innovations is essential, as highlighted in recent research recommendations."
Greenhalgh disclosed financial ties to BIBA Medical and Spaceform Holdings and has served as an expert witness for vascular disease patients. Two co-authors disclosed financial ties to Medtronic.