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ClosePatient Preference and Quality of Life Issues in Abdominal Aortic Aneurysm
A significant factor in the choice of treatment plan for abdominal aortic aneurysm (AAA) is patient preference. This includes the decision for small AAAs regarding surveillance or early elective surgery and, if surgery is to be performed, which type of surgical repair. Certain factors may limit these options regardless of patient preference, (e.g., presence of risk factors as discussed above). However, in the absence of having a high risk profile, much of the decision rests upon the patient. It is, therefore, very important for the individual with an abdominal aortic aneurysm to be well informed regarding their condition so that they can make appropriate decisions regarding treatment for their AAA.
A patient may prefer to either wait or to proceed with elective surgery for repair of an abdominal aortic aneurysm if the operative risk is low. Studies indicate that early elective surgery does not prolong long-term survival, however, it does impact significantly on the perceived quality of life of patients who felt that they were doing something proactive about their condition. Patients may want to take various considerations under advisement regarding this choice, including:
- Quality of life - some individuals cannot cope with the uncertainty of risk of rupture
- Size of the AAA - since up to 60% or more of patients eventually require surgery, some patients may prefer to undergo elective repair early (e.g., young people with AAAs in the range of 4.5 - 5.5 cm. diameter). Some estimates indicate that approximately 50% of patients for whom the diameter of the aneurysm was 4.5 - 4.9 cm. at the time of diagnosis underwent surgical repair within 5 years and up to 80% of people whose diameter was 5.0 - 5.4 cm. underwent repair.
- Evaluation of the degree of the patient's commitment to ongoing surveillance for expansion of their AAA and the impact of long-term surveillance on the patient's quality of life.
If an individual's risk profile is low and they elect to undergo surgery, the decision of whether to choose open AAA repair or EVAR may be based on considerations of each procedure such as:
- Length of hospital stay
- Recuperation time
- Risk of complications
- Risk of reintervention
- Quality of life after surgery
In comparing responses to a questionnaire regarding quality of life of patients who opted for surveillance of their abdominal aneurysms vs. patients who opted for surgical intervention, some male patients who underwent open AAA repair surgery reported an increased incidence of impotence at 1 year post-surgery but still indicated more of an improved perception of their overall general health for the first few years following surgery than did those patients in the surveillance group. For both groups, quality of life perceptions (e.g., physical functioning, general health, social interactions) declined, but this may also have been related to the fact that the majority of people diagnosed with AAAs are older to begin with and these negative perceptions related to quality of life may reflect the effect of the aging process.
In studies evaluating quality of life issues after elective surgery for the repair of abdominal aortic aneurysm, patients' responses to questions regarding post-surgical quality of life were, on the average, similar for both procedures (some differences appear in various studies). Two clinical trials were published in the Netherlands in 2004 comparing responses to questionnaires regarding quality of life of a group of patients who underwent EVAR and a group who underwent open repair for AAA. Results indicated that:
Regarding overall quality of life one month after surgery, the group who underwent EVAR reported a better quality of life than those who underwent open repair. However at 6 months postsurgery, those who underwent open repair reported a better quality of life than those who underwent EVAR.
Regarding health-related aspects of quality of life (limitation of functioning due to pain, or loss of vitality), both groups scored significantly lower one month post-surgery than they scored preoperatively. However, at three months, scores of both groups were comparable to their preoperative levels of functioning.
While initially the EVAR group scored higher on health-related quality of life issues, by three months after surgery, both groups reported similar scores. This indicates that the benefit of EVAR on health-related quality of life appears to be short-lived.
You can see additional information about theses clinical trials by clicking on the following link:
In 2006, a study was published with results of a pilot study on sexual dysfunction following open repair of AAA and EVAR. Both types of surgery had a negative impact on the sexual dysfunction aspect of quality of life. The greatest difference in sexual dysfunction between the preoperative and postoperative (1-2 years) periods was reported by patients who under went elective open repair (27% of patients before surgery to 58% post-surgery). The differences for those who underwent EVAR were not as great (63% preoperative to 76% postoperative). The baseline for sexual dysfunction preoperatively was higher among patients undergoing EVAR since they tended to have more comorbid conditions which prevented them from being candidates for open surgical repair.
In-depth coverage of this issue is viewable by clicking on the following link: