• About
  • Masthead
  • License Content
  • Advertise
  • Submit Press Release
  • RSS/Email List
  • Write for us
  • Contact us
2 Minute Medicine
No Result
View All Result

No products in the cart.

SUBSCRIBE
  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • AccountLog-in/out
    • Subscribe
    • Sign-in
    • My account
2 Minute Medicine
  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • AccountLog-in/out
    • Subscribe
    • Sign-in
    • My account
SUBSCRIBE
2 Minute Medicine
Subscribe
Home All Specialties Cardiology

[Featured | Physician Comment] Endovascular repair of aortic aneurysm increases survival in younger patients, while open repair benefits patients over 70 years of age

bys25qthea
December 8, 2012
in Cardiology, Chronic Disease, Surgery
Reading Time: 3 mins read
0
Share on FacebookShare on Twitter

Image: PD. Abdominal Aneurysm

Study author, Dr. Frank A. Lederle, MD talks to 2 Minute Medicine: Professor of Medicine, University of Minnesota School of Medicine

“The study is most important as a reminder that whatever our enthusiasm for new treatments, we need always to check the facts. Endovascular repair has been eagerly accepted in part as a way to extend the indications for AAA repair to those who aren’t candidates for open repair – people with medical contraindications to surgery or small AAA (less than 5.5 cm). But while EVAR is a very good technique for the same patients who are candidates for open repair, it is not better in the long run and should not be used in these other populations. This comes from a number of randomized trials (including EVAR-2, PIVOTAL, and CAESAR), our study is the latest to confirm and extend our understanding of this principle.”

 

Key study points:

1. Patients under 70 with an asymptomatic abdominal aortic aneurysm receive a survival benefit from elective endovascular repair, while those over 70 have longer survival with an open repair.

2. Endovascular repair reduces perioperative mortality, but there is no significant difference in long-term all cause mortality between EVAR and open repair.

RELATED REPORTS

Relugolix combination therapy is efficacious for endometriosis-associated pain

Age-based products and longer interdose intervals may reduce the risk of cardiac disease following COVID-19 mRNA vaccination

OPTN and UNOS update policy regarding hepatocellular carcinoma [Classics Series]

Primer: Abdominal aortic aneurysm (AAA) is an abnormal dilation of the wall of the aorta that can result in the acutely life-threatening complication of rupture. Predisposing risk factors for an AAA include age, male gender, smoking, hypertension and family history. AAAs are predominantly infrarenal and are commonly discovered on physical exam or incidentally during an evaluation of an unassociated abdominal problem. Size is the major determinant in the decision to proceed with operative repair. Asymptomatic AAAs under 5cm are followed for growth with serial ultrasounds. Aneurysms over 5cm or those that grow at a rate over 4mm/year are repaired electively depending on the medical condition of the patient. Open repair involves suturing a graft to the normal aorta and then wrapping the aneurysm wall around the graft. Endovascular repair (EVAR) entails threading a catheter through peripheral access such as the femoral artery and placing a graft intravascularly at the aneurysm site. To proceed with EVAR, the patient must have a minimally angulated aneurysm neck below the renal arteries that’s at least 1-1.5 cm long and at least one suitable common iliac for fixation of the graft at the site. Endovascular repair was introduced as a less invasive method for intervention and has been shown to reduce perioperative mortality, but has also been associated with higher rates of late deaths due to AAA rupture. Traditionally, due to the decreased perioperative mortality EVAR has been preferred for patients with a worse prognosis.

Background reading:

1. The UK EndoVascular Aneurysm Repair (EVAR) trials: randomised trials of EVAR versus standard therapy.

2. Outcomes following endovascular vs open repair of abdominal aortic aneurysm: a randomized trial. (OVER Veterans Affairs Cooperative Study).

This [randomized controlled] trial divided 881 patients to either endovascular or open repair with up to 9 years of follow-up. Mean patient age was 70 and almost all were men with a maximum AAA diameter of 5.7 cm. The primary outcome of the study was all-cause mortality – with 146 deaths occurring in each cohort. Perioperative mortality, defined as death during hospitalization or within 30 days of the surgery, was significantly lower in the EVAR group vs. open repair (0.5% vs. 3.0%, p = 0.0004). EVAR also resulted in better survival in patients less than 70 years old. This treatment interaction disappeared for patients over 70 years old, who had marginal benefit with open repair, as opposed to EVAR (p=.06).

In sum: This trial supports previous evidence that EVAR has reduced perioperative mortality that extends to up to three years. Although EVAR carries a higher risk for late death due to rupture, this trial demonstrates that open and endovascular repair have similar long-term mortality. Endovascular repair provided more survival benefit for patients under 70, while patients at or over 70 years of age had longer survival with open repair. This finding contradicts traditional views that the less invasive EVAR is more beneficial for older, higher-risk patients.

Click to read the study in NEJM

By [AO] and [AH]

© 2012 2minutemedicine.com. All rights reserved. No works may be reproduced without written consent from 2minutemedicine.com. Disclaimer: We present factual information directly from peer reviewed medical journals. No post should be construed as medical advice and is not intended as such by the authors or by 2minutemedicine.com. PLEASE SEE A HEALTHCARE PROVIDER IN YOUR AREA IF YOU SEEK MEDICAL ADVICE OF ANY SORT.   

Previous Post

Drug-eluting stents in peripheral artery disease: longer patency than bare stents but no significant improvement in long-term limb viability (ACHILLES trial)

Next Post

Single level fusion provides equivalent outcomes to multilevel fusion for treating degenerative spondylolisthesis

RelatedReports

Chronic Disease

Relugolix combination therapy is efficacious for endometriosis-associated pain

June 30, 2022
Novel coronavirus identified from patients with pneumonia in Wuhan, China
Cardiology

Age-based products and longer interdose intervals may reduce the risk of cardiac disease following COVID-19 mRNA vaccination

June 30, 2022
The ABCD2 score: Risk of stroke after Transient Ischemic Attack (TIA) [Classics Series]
Hematology/Oncology Classics

OPTN and UNOS update policy regarding hepatocellular carcinoma [Classics Series]

June 30, 2022
Nearly Half of All Pediatric Buprenorphine Exposures Result in Hospitalization
Chronic Disease

ACKR1 variant increases risk of azathioprine-related hematopoietic toxicity

June 30, 2022
Next Post

Single level fusion provides equivalent outcomes to multilevel fusion for treating degenerative spondylolisthesis

No association found between third trimester maternal NSAID use and newborn pulmonary hypertension

Breastfeeding peer counseling does not improve exclusive breastfeeding rates in obese, low-income women

License Our Award-Winning Physician-Written Medical News and Visual Abstracts

2 Minute Medicine is the leading authoritative medical news licensing service, and the only with reports written by practicing doctors.

LICENSE CONTENT

2MM+ Premium Access

No ads & unlimited access to all current reports, over 9000 searchable archived reports, visual abstracts, Weekly Rewinds, and the online edition of The Classics Series™ textbook.

Subscription Options
2 Minute Medicine

2 Minute Medicine® is an award winning, physician-run, expert medical media company. Our content is curated, written and edited by practicing health professionals who have clinical and scientific expertise in their field of reporting. Our editorial management team is comprised of highly-trained MD physicians. Join numerous brands, companies, and hospitals who trust our licensed content.

Recent Reports

  • Relugolix combination therapy is efficacious for endometriosis-associated pain
  • Age-based products and longer interdose intervals may reduce the risk of cardiac disease following COVID-19 mRNA vaccination
  • OPTN and UNOS update policy regarding hepatocellular carcinoma [Classics Series]
License Content
Terms of Use | Disclaimer
Cookie Policy
Privacy Statement (EU)
Disclaimer

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.

  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • Account
    • Subscribe
    • Sign-in
    • My account

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.