Presentations Highlight EVAR for Ruptured AAA Treatment

January 18, 2010—Research on the treatment of ruptured abdominal aortic aneurysms (rAAAs) was presented at the 22nd Annual International Symposium on Endovascular Therapy (ISET) in Hollywood, Florida on January 17 through 21, 2010.

Jantje Ten Bosch, MD, presented a study that compared the results of 25 patients who underwent endovascular aneurysm repair (EVAR) to 33 patients who underwent open surgery. All 58 patients were determined to be EVARsuitable by independent reviewers. Dr. Ten Bosch reported that 4% of patients undergoing EVAR died compared to 6% of patients who died undergoing open surgery. After 6 months, 28% of the EVAR patients and 55% of the open surgery patients had died—a 27% reduction in mortality with EVAR compared to open surgery, which was statistically significant. The average hospital stay for EVAR patients was 8 days compared to an average of 17 days for those who underwent open surgery.

“Although studies have shown EVAR can be used in an emergency situation, this is the first study to compare EVAR and open surgery on a level playing field, because all of the patients were deemed EVAR-suitable,” commented Dr. Ten Bosch. “These data strongly suggest that EVAR is a valuable treatment option in EVAR-suitable patients with an rAAA.”

Dr. Ten Bosch also presented preliminary research suggesting that a simple blood test may be able to detect when endoleaks in AAAs are occurring, potentially preventing up to 90% of follow-up computed tomography scans, which are costly and involve high doses of radiation and use contrast dye that can damage the kidneys.

According to Dr. Ten Bosch, investigators found that higher concentrations of the blood protein matrix metalloproteinase- 9 (MMP-9) accurately predicted which patients had an endoleak. The study included a total of 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 investigators determined that MMP-9 concentrations of 55.18 ng ml^-1 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 Dr. Ten Bosch. However, the results must be confirmed by a prospective clinical validation trial, he advised.