Minimally invasively emergency repair of ruptured abdominal aortic aneurysms could save more lives in some cases than traditional open surgery, suggests new data presented on 18 January 2010 at the 22nd annual International Symposium on Endovascular Therapy (ISET) in Hollywood, Florida, USA.
A study compared the results of 25 patients who underwent EVAR to 33 who underwent open surgery. All 58 patients were determined to be EVAR-suitable by independent reviewers, meaning that the anatomy of the blood vessels used to access the aneurysm, as well as the aneurysm itself, were favourable for the procedure. Four per cent of patients died during the EVAR procedure, compared to 6% during open surgery. After six months, 28% of the EVAR patients and 55% of the open surgery patients had died – a 27% reduction in mortality for EVAR compared to open surgery, which was statistically significant. The hospital stay for open surgery patients averaged 17 days, compared to an average of eight days for EVAR patients.
“Although studies have shown EVAR can be used in an emergency situation, this is the first to compare EVAR and open surgery on a level playing field because all of the patients were deemed EVAR-suitable,” Jantje Ten Bosch, a surgery resident at Atrium Medical Center, Heerlen, The Netherlands, who presented the study at ISET. “This data strongly suggest that EVAR is a valuable treatment option in EVAR-suitable patients with ruptured aneurysms.”
Blood test can identify leaks
Preliminary research also presented by Bosch suggests a simple blood test may be able to detect when such a leak is occurring, potentially preventing up to 90% of follow-up computed tomography scans.
Researchers found that higher concentrations of a blood protein called matrix metalloproteinase-9 (MMP-9) accurately predicted which patients had an endoleak. The study included 37 patients, 17 consecutive patients who had an endoleak matched with 20 who did not, all of which were confirmed by computed tomography. All patients with an endoleak had elevated concentrations of MMP-9, compared to only one patient without an endoleak. In that patient, concentrations were only slightly elevated, and researchers determined MMP-9 concentrations of 55.18 or greater can identify endoleaks with both high sensitivity and specificity.
“The study is the first to show that concentrations of MMP-9 might accurately discriminate between patients with and without an endoleak,” said Bosch. The results must be confirmed by a prospective clinical validation trial, he said.
