PHILADELPHIA — Endovascular repair for abdominal aortic aneurysms appeared safer than open repair in a retrospective analysis of more than 2,000 high-risk patients who underwent aneurysm repair in the Veterans Affairs' health system.
“EVAR [endovascular aneurysm repair] should be considered the alternative of choice for patients at high risk for aneurysm repair,” Dr. Ruth L. Bush said at the Vascular Annual Meeting.
The study used data from the U.S. Department of Veterans Affairs' National Surgical Quality Improvement Program, which is the largest prospectively collected and validated U.S. surgical database. The analysis focused on the approximately 3,400 patients who underwent abdominal aortic aneurysm (AAA) repair during May 2001-December 2004.
From this group, Dr. Bush, a vascular surgeon at Baylor College of Medicine, Houston, and her associates analyzed data on 2,368 high-risk patients. The researchers' definition of high risk included patients aged 60 or older who were classified as having grade III or IV disease by the criteria of the American Society of Anesthesiologists. The high-risk subgroup was further defined as having at least one of these additional conditions: a history of cardiac, respiratory, or hepatic disease; a history of coronary revascularization; renal dysfunction; or a serum albumin level of less than 3.4 g/dL.
The outcomes of 788 EVAR patients were analyzed, and compared with those of 1,580 open surgery patients with regard to 30-day mortality rate, 1-year death rate, and total complications rate. (See box.) In an analysis that adjusted for baseline differences between the two treatment groups, EVAR was associated with statistically significant reductions for all three measures, compared with the open-surgery group, Dr. Bush said.
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