Endovascular Aneurysm Repair – To Avoid Rupture or to Improve Quality of Life?

Abstract

Surgical treatment of small abdominal aortic aneurysms (AAA) does not save lives. The UK small aneurysm trial and the ADAM trial both showed this after open repair. Although endovascular repair is associated with a lower perioperative mortality, the CAESAR and PIVOTAL trials confirmed this finding regarding endovascular repair (EVAR) of small AAAs. The current study by De Rango et al. indicates that despite the lack of survival benefit, stentgraft treatment might have a beneficial effect on the patient’s health from a quality of life perspective. Quality of life of patients with AAA has been studied in different circumstances previously. Screening studies indicate that detection of an AAA has a small negative effect on a patient’s quality of life, which is corrected by surgical treatment of the aneurysm. Additionally, based on studies of open repair of patients with small AAAs, surgical treatment of small aneurysms results in a short-term improvement of quality of life. When comparing quality of life after open and endovascular repair, there is a shortterm benefit for EVAR, which is potentially offset by a longterm benefit for open repair. Open surgical treatment of a small aneurysm purely based on quality of life criteria is not a realistic option when the treatment itself carries a 3e5% risk of mortality.