Abstract 2134: Different Outcome and Quality of Life Following Surgical or Interventional Treatment of Descending Aortic Aneurysms
Objective: Surgery of the downstream aorta is still technically demanding and may be followed by conbsiderable perioperative mortality and morbidity. Endovascular repair with stent graft placement (EVAR) represents an attractive alternative to open graft interposition in selected patients. Aim of the present study was to assess outcome and quality of life (QoL) in patients with descending aortic pathologies treated either by EVAR or open graft interposition.
Methods and Results: Between 01/01 and 12/05 138 patients underwent surgery of the downstream aorta. 59 patients (42.8%) were treated by EVAR and 79 (57.2%) with open graft interposition. All in hospital data were assessed and a follow-up was performed. QoL was analyzed with the short form 36 health survey questionnaire (SF-36) and the HADS-questionnaire was used to focus on aspects of anxiety and depression. Average age was significantly higher in the EVAR-group compared to the open repair group (67.0±8.7 y vs. 61.0±9.2 y; p<0.05). 30-day mortality was 5.1% in the surgical group and 0% in the EVAR-group (p<0.05). Average follow-up was 32.1±14.2 months, without statistical significant difference between the two groups. Mortality during follow-up was significantly higher in the EVAR-group. QoL was significantly impaired following EVAR-treatment (with lower scores in the aspects general health, vitality and bodily pain) compared to the open repair group. Anxiety and depression was slightly higher in the EVAR-, than in the open repair group.
Conclusions: Both EVAR and open repair provide excellent results in the treatment of the diseased downstream aorta. Due to selection criterias, EVAR patients are older and present with a higher incidence of comorbidities. Mortality in the follow-up is significantly higher in the EVAR-group. QoL is similar to an age and gender matched standard population in the open repair group, but in the EVAR-group there are surprisingly significant limitations in physical health aspects. Anxiety- and depression-score are higher in the EVAR-group, reflecting a certain incertitude against this new technique.