Repairing a bulging aorta from within is safest in the short term

Minimally invasive surgery for a bulging artery below the heart is much safer than open surgery in the short term, but the advantage fades over time, according to a study in The New England Journal of Medicine.

An abdominal aortic aneurysm (AAA) occurs when a portion of the aorta, the main blood vessel carrying blood from the heart to the lower part of the body, becomes enlarged and bulges out. If the bulge ruptures, it is usually fatal. This condition is more common in older men than in women.

In an endovascular AAA repair, the surgeon threads a thin, flexible instrument up to the trouble site through a small incision in the leg and installs a reinforcing fabric-and-mesh patch. The alternative is major open surgery, requiring a large incision in the abdomen.

Researchers examined Medicare records from 2001 to 2008, covering nearly 80,000 people who had undergone repair for an AAA. Half had endovascular repair, and the remainder had open surgery. In the first month after surgery, 1.6% of the participants who had endovascular procedures died, in contrast to 5.2% of those who had open surgery. The survival advantage of endovascular repair persisted for several years.

Over the longer term, however, the advantage wore off, and someone who had an endovascular repair was more likely to need additional procedures. The chance of a sudden rupture later on was also higher in people who got endovascular repair.

Still, the minimally invasive procedure can be a good choice for older, sicker people at greater risk of death in the short term. Because they have a shorter life span, the chance of the endovascular patch failing years down the road is less of a concern.