An abdominal aortic aneurysm is a potentially fatal bulge in the aorta, the main blood vessel out of the heart. Surgeons have come up with a new technique, called endovascular repair or EVAR, in which a stent and graft are guided from small incisions in the groin, through the arteries to the location of the aneurysm. Although people who have EVAR stay in the hospital for a shorter time and recover more easily than people who have open surgery, the procedure is still more expensive than open surgery—and it's also not suited to everyone's aneurysm. Researchers at UCLA Medical Center reviewed EVAR and another method of repair, which they think is a good alternative.

What the researchers wanted to know: How does endovascular repair compare with retriperitoneal repair of abdominal aortic aneurysms?

What they did: Retroperitoneal repair is an open method of repairing aortic aneurysms; it was suggested about 40 years ago as an alternative to the classic technique, the transperitoneal technique. The researchers looked back at all 150 patients who'd had abdominal aortic aneurysms repaired at their medical center in 2001 and 2002; all of these aneurysms were below the kidneys (which is usual for these aneurysms). About 60 percent of them had retriperitoneal repair, and the rest had EVAR.

What they found: Patients who had retriperitoneal repair stayed in the hospital longer than endovascular repair patients, and more of them had complications that required them to stay in the hospital for more than two weeks. They also lost more blood during surgery, and more of them had to spend time in the intensive care unit while recovering.

What the study means to you: Endovascular repair still looks like a better option. But some aneurysms just can't be fixed that way. Although people in this study who had retroperitoneal repair done stayed in the hospital longer than those who had endovascular repair, they nevertheless were out much faster than people having abdominal aortic aneurysm repairs used to be; and the authors say retroperitoneal repair is probably still better than the classic transperitoneal repair.

Caveats: Patients weren't randomly assigned to one procedure or the other. In fact, the people who were getting open retroperitoneal surgery probably needed more complex repairs, which could also affect their recovery. Also, no one knows how endovascular repair patients do in the long term—whether their grafts will hold for decades.

Find out more: The article on abdominal aortic aneurysms in the National Library of Medicine's medical encyclopedia includes symptoms and diagrams.

Does a less invasive way of repairing abdominal aortic aneurysms work as well as open surgical repair?

Read the article: Rigberg, D.A., et al. "Abdominal Aortic Aneurysm: Stent Graft vs Clinical Pathway for Direct Retriperitoneal Repair." Archives of Surgery. September 2004, Vol. 139, pp. 941-946.

Abstract online: http: http://archsurg.ama-assn.org