Aneurysm repair: less invasive approach better

CHICAGO (Reuters) - A less-invasive way to repair a dangerous bulge in the body's main artery may be the best choice for many people, U.S. researchers said on Wednesday.

A large study found the newer technique, known as endovascular repair, had lower short-term rates of death and complication than an older, more-invasive surgery.

And while it had more long-term complications than the older surgery, these were easier to treat than those that arose with the more older, surgical approach.

"I do these all of the time. This makes me feel even better about recommending endovascular repair for patients with the appropriate anatomy," said Dr. Marc Schermerhorn of Harvard Medical School and Beth Israel Deaconess Medical Center, whose study appears in the New England Journal of Medicine.

About four out of every 100 adults develop an abdominal aortic aneurysm, in which the vessel that supplies blood to abdomen, legs and pelvis swells to more than one and a half times its normal size.

A ruptured abdominal aortic aneurysm is the 10th leading cause of death in men over age 55 in the United States. Fewer than 20 percent of people survive a rupture.

Doctors have traditionally repaired the weakened vessel using open surgery involving a long incision in the torso. Surgeons then sew on a patch or graft to reinforce the aorta.

In endovascular repair, doctors deliver the graft through a catheter inserted into a small incision in the groin which is threaded through the body. Recovery time is much shorter, but the grafts have been shown to be less durable.

Schermerhorn's team looked at more than 45,000 patients enrolled in Medicare who had been treated for an abdominal aortic aneurysm. About half had open surgery and the other half had the less-invasive procedure.

Nearly 5 percent of people who had open surgery died right afterward, compared with 1.2 percent of the patients who underwent endovascular repair.

Schermerhorn said 9 percent of the endovascular repair group needed repeat procedures compared with 1.7 percent of the open surgery group.

But because the open surgery is a much more invasive procedure, complications needing surgery were more than twice as high four years after the procedure for open repair patients.

"You are not free from intervention with open surgery," Schermerhorn said.

After weighing all the risks and benefits, he said the endovascular repair appears to be the better choice.

(Editing by Will Dunham and Cynthia Osterman)