Nearly 40,000 Americans undergo elective surgery per year to repair an abdominal aortic aneurysm (AAA) with the goal of preventing a life-threatening rupture. A new study from researchers at Beth Israel Deaconess Medical Center compared open surgical repair of AAA with a catheter-based procedure and found that the less invasive endovascular aortic repair (EVAR) has clear benefits for most patients, providing both a safer operation and a quicker recovery. The study was published July 22 in The New England Journal of Medicine.
An aneurysm occurs when a blood vessel becomes abnormally large or balloons outward. The abdominal aorta is a large blood vessel that supplies blood to your abdomen, the pelvis, and legs. When a weak area of the abdominal aorta grows, it is called an abdominal aortic aneurysm (AAA). AAA can develop in anyone, but it is primarily seen in men over 60 with one or more risk factors. The larger the aneurysm, the more likely it is to rupture which can cause massive internal bleeding and can be fatal. When diagnosed early, abdominal aortic aneurysms can be treated, or even cured, with highly effective and safe treatments.
Aneurysms can be caused by inflammation in the aorta, which may cause its wall to break down. Some researchers believe that this inflammation can be associated with atherosclerosis (hardening of the arteries). Besides atherosclerosis, other factors that can increase your risk of abdominal aortic aneurysm include:
- Being a man older than 60 years
- Family History of AAA
- Having high blood pressure
- Smoking
- A pulsing feeling in the abdomen, similar to a heartbeat
- Severe, sudden pain in your abdomen or lower back. If this is the case, your aneurysm may be about to rupture.
Endovascular aortic repair (EVAR) has become widely used to treat AAA as compared to traditional open surgery. During the study, researchers found that EVAR was superior to open surgical repair and that this minimally invasive procedure has been increasing and improving over time. Findings also suggest that even as sicker patients have undergone EVAR, the short- and long-term outcomes have continued to improve with favorable outcomes.
Endovascular treatments have many benefits including: patients typically leave the hospital sooner and recover more quickly, have less pain and a lower risk of complications and lower mortality than traditional surgery because the incisions are smaller. Sometimes traditional surgery is required if the shape or the location of the aneurysm is not favorable for an endovascular treatment.
According to the lead author of the study Marc Schermerhorn, MD, AAA rupture is still a common cause of death. “Because there are typically no warning signs, heightened awareness among patients and physicians is needed. AAA can be diagnosed with a simple ultrasound and can now often be treated with an effective, durable, minimally invasive approach”, said Schermerhorn.
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