RS09 Prospective, Nonrandomized Assessment of Health-Related Quality of Life Changes in Patients Treated for Pararenal and Thoracoabdominal Aortic Aneurysms With Fenestrated and Branched Endografts

Abstract

This study investigated changes in health-related quality of life (QOL) in patients treated for pararenal (PRA) and thoracoabdominal aortic aneurysms (TAAAs) with fenestrated-branched endovascular aortic repair (F-BEVAR). A total of 165 patients (114 male; mean age, 75 ± 7 years) were enrolled in a prospective, nonrandomized single-center study using manufactured F-BEVAR (2013-2016). Patient health-related QOL measures were assessed using the Short-Form 36 Health Survey questionnaire prior to treatment and at 1 month, 6 months, and yearly follow-up. Physical component scores (PCS) and mental component scores were compared to historical results of patients enrolled in the EVAR 1 trial who were treated by open surgical repair (OSR) or standard endovascular aortic repair (EVAR) for AAAs. There were 58 PRAs, 52 extent IV and 55 extent I to III TAAAs. A total of 646 renal-mesenteric arteries were incorporated by fenestrations or branches with mean of 3.9 ± 0.2 vessels per patient. Technical success for branch vessel incorporation was 99.6%. There were no 30-day or in-hospital deaths, conversions to OSR, or aortic-related deaths. Mean follow-up was 14 ± 9 months. A total of 531 QOL questionnaires were completed (3.2 ± 0.8/patient). Follow-up >30 days was obtained in all patients, >6 months in 130, >12 months in 96, and >24 months in 38. Patient survival was 95% ± 2% at 1 year and 82% ± 4% at 2 years, without a difference between groups. PCS declined after the operation in all aneurysm groups, returning to baseline at 12 months for patients with PRAs but not for those with TAAAs (P < .05). Patients with PRAs had significantly higher PCS at 12 months when compared to those with TAAAs (P < .001, Fig 1). There were no changes in mental component scores. The only independent predictor for decline in PCS was a higher PCS prior to the operation (P < .0001). Major adverse events were associated with early decline in PCS at 30 days (P < .05) but were not associated with late QOL changes in subsequent evaluations. Reinterventions had no effect on QOL measures. Overall, patients treated by FEVAR had similar changes in QOL measures when compared to historical OSR and EVAR controls (Fig 2). PCS were lower at 12 months for patients treated by FEVAR for TAAAs compared to OSR or EVAR controls. F-BEVAR was associated with significant decline in PCS, which returned to baseline values at 12 months in patients with PRAs but not in those with TAAAs. Patients treated for PRAs had similar changes in QOL compared to those treated for AAAs.Fig 2Comparison of Short Form 36 Health Survey (SF-36) physical component score (PCS) score among patients who underwent to fenestrated-branched endovascular aortic repair (F-BEVAR; Mayo Clinic series) and EVAR1 trial groups (EVAR1 EVAR and EVAR1 open repair). EVAR, Endovascular aortic aneurysm repair.View Large Image Figure ViewerDownload Hi-res image Download (PPT)