Age-Related Differences in Quality of Life After 5 Years From Endovascular and Open Repair of Abdominal Aortic Aneurysms

Abstract

Abdominal aortic aneurysms are increasingly treated by endovascular aneurysm repair (EVAR), with results comparable to open repair (OR) in the short term and midterm for quality of life (QoL). Data on long-term results are scarce, however, particularly when considering age-related differences. The aim of this study was therefore to highlight the long-term QoL differences between EVAR and OR, with particular attention to the impact of age. To achieve a 5-year follow-up, all standard EVARs and infrarenal ORs, performed electively from January to December 2013, were analyzed and divided into two subgroups: younger patients (YPs), aged <70 years at intervention; and older patients (OPs). QoL was evaluated through a 36-Item Short Form Health Survey (SF-36) questionnaire and a disease-specific questionnaire (DSQ), with attention to sexual activity, surgical access complications, leg weakness/claudication, fatigue, and insomnia. The correlations between age group, type of procedure, and clinical outcomes were analyzed. Of a total of 141 patients submitted to abdominal aortic aneurysm repair (31 deaths, 19 lost), 91 were available for 5-year follow-up analysis (42%-46% YPs, 64 ± 5 years; 49%-54% OPs, 77 ± 3 years). Mean follow-up was 60 ± 10 months. OPs underwent OR in 22% and EVAR in 78%, YPs in 64% and 36%, respectively. Analyzing OPs, OR compared with EVAR showed worsening of QoL in both SF-36 (physical limitations, P = .005; perception of general health, P = .015; mental health, P = .000) and DSQ (sex impairment, 46% vs 5% [P = .004]; leg weakness/claudication, 72% vs 21% [P = .003]; and fatigue, 72% vs 10% [P = .000]). In YPs, QoL was overall comparable between the two techniques, with sexual activity as the unique worsened aspect after OR vs EVAR by DSQ (52% vs 13%; P = .014). Reintervention rate was higher after OR in OPs (36% vs 5%; P = .018) with no difference in YPs (OR, 18%; EVAR, 27%; P = NS). Need for follow-up did not represent an issue for any patient in either group. This study highlights the role of patient age on long-term QoL after OR and EVAR, with worse QoL outcomes after OR in OPs both in SF-36 and DSQ. YPs did not show this differences; however, sexual activity was significantly worsened after OR. In terms of QoL, EVAR should be proposed as a preferential option in OPs. YPs have similar QoL after either procedure; however, the risk of long-term sexual impairment should be considered in the decision-making process.