Endovascular or endograft repair, a minimally invasive interventional radiology treatment that uses stent grafts to treat abdominal aortic aneurysms (AAA), has low re-intervention rates that are comparable to those reported for open surgical repair-and can be recommended as first-line treatment, according to a study released at the Society of Interventional Radiology's 34th Annual Scientific Meeting.
Currently this less invasive treatment has been reserved for elderly patients or those with co-morbid conditions who were considered too sick for major surgery. Stent grafts (tubes composed of fabric supported by metal mesh) were introduced about a decade ago. Because the devices were new, long-term durability was unknown, and there was initially a higher rate of secondary interventions compared to open surgery, it was recommended that patients with endografts be monitored yearly with imaging, subjecting them to annual radiation. "Our data show that the interventional radiology treatment can be chosen with confidence. This is good news for patients, many of whom do not want major abdominal surgery," said Tarun Sabharwal, M.D., interventional radiologist at Guy's and St. Thomas' Hospitals in London, England. Additionally, the researchers advocated revising current surveillance of patients' stent grafts by CT scans to check for delayed appearance of complications, especially in light of the added radiation risk the scans bring to patients.
AAA, called the "silent killer" because there are usually no obvious symptoms of the disease, is caused by a weakened area in the aorta, the main vessel that supplies blood from the heart to the rest of the body. When blood flows through the aorta, the pressure of the blood beats against the weakened wall, which then bulges, balloon-like, into an aneurysm. If the aneurysm grows large enough, there is a danger that it will burst. The goal is to prevent aneurysms from rupturing. Once an AAA has ruptured, the chances of survival are low, with 80 to 90 percent of all ruptured aneurysms resulting in death. These deaths can be avoided if an aneurysm is detected and treated before it ruptures. AAA is the 17th leading cause of death in the United States, accounting for more than 15,000 deaths annually. AAA affects as many as 8 percent of people over the age of 60, and men are four times more likely to have AAA than women.