A new study may help older people and their doctors decide how to treat a very common and dangerous problem: a bulging abdominal artery threatening to burst.

Fixing these weak spots by inserting a fabric sleeve into the artery, like a new tube in a bicycle tire, led to fewer deaths and complications than traditional surgery to implant this patch, the study found.

The study involved more than 45,000 Medicare patients, average age 76, with “AAAs,” or abdominal aortic aneurysms. More than 200,000 of these are diagnosed in the United States each year. The number is growing since the government recently recommended screening male smokers over 55 for the problem, which is often fatal if the vessel bursts. (Women, younger men and non-smokers are less at risk.)

In the study, nearly 5 percent of patients died after surgery, versus about 1 percent of those treated the less invasive way. After four years, the non-surgery group was three times more likely to suffer a rupture, but this risk was small and offset by other complications in the surgery group.

The study was led by doctors at Harvard University and Beth Israel Deaconess Medical Center in Boston, with Medicare researchers. Results were published in today’s New England Journal of Medicine.

“This represents a real-world look” at results in ordinary hospitals, not just in big research centers, said Dr. Barry Katzen, medical director of Baptist Cardiac and Vascular Institute in Miami. He has been involved in key studies on the less invasive procedure and has consulted for at least one device maker.

Four brands of these artery patches are sold in the United States and cost $10,000 to $15,000. Including this expense, surgery costs $35,000 to $40,000 – about $5,000 more than the less invasive approach, Katzen said.

“Aneurysms do run in families,” so anyone with that history should be checked, which is done with a painless ultrasound exam or CT scan, he said.