Newswatch: May 2006

Less-invasive technique improves outcomes of abdominal aortic aneurysm repair

According to the results of a recent study, a shift toward less-invasive endovascular procedures as an alternative to conventional aneurysm repair has reduced the risk of death for patients undergoing repair of abdominal aortic aneurysms (AAAs).

"Our results show that vascular surgeons are saving more lives through the increased use of endovascular AAA repair—even while operating on older and less-fit patients," said Ellen D. Dillavou, MD, assistant professor of surgery at the University of Pittsburgh and the study's lead author. Dillavou and her colleagues used Medicare data to analyze trends in AAA surgery from 2000 to 2003.

An abdominal aneurysm is a bulging of the aorta; a burst or ruptured aneurysm usually results in death. If detected through proper screening, AAAs can be repaired to prevent rupture. However, traditional open surgery for AAA is a major operation with a significant risk of death and prolonged recovery time.

Endovascular aneurysm repair (EVAR) provides a less-invasive alternative to open surgery for AAA repair. In this procedure, the vascular surgeon makes a small incision in the groin to place a fabric-covered stent through the patient's arteries. Once this graft reaches the location of the aneurysm, it is expanded and fixed in place to repair the aneurysm.

From 2000 to 2003, AAA repair was performed in about 28,000 elderly Medicare patients per year. The use of EVAR increased steadily after 2000, the first year Medicare recognized the procedure. By 2003, EVAR composed more than 40% of AAA repairs. The results of the study, called "Improving aneurysm-related outcomes: Nationwide benefits of endovascular repair," were reported in the March issue of The Journal of Vascular Surgery.

In further efforts to decrease the death rate from AAA, the Screening Abdominal Aortic Aneurysms Very Efficiently (SAAAVE) Act was signed into law by President Bush earlier this year. The signing culminates the efforts of the Society for Vascular Surgery (SVS of Chicago), a not-for-profit association leading the National Aneurysm Alliance and which brought the issue to the attention of Congress.

This new law will make AAA screening a covered benefit under Medicare beginning January 1, 2007. SAAAVE was created as a response to a recommendation by the US Preventive Services Task Force that men between the ages of 65 and 75 who have ever smoked obtain a one-time screening for AAA via abdominal ultrasonography. Medicare also will cover the procedure for men and women with a family history of AAA.