Quality of Life of Patients Treated for Abdominal Aortic Aneurysm: Open Surgery and Endoprosthesis

Innovation in pathogenesis and management of aortic aneurysm

Aortic aneurysm (AA) refers to the persistent dilatation of the aorta, exceeding three centimeters. Investigating the pathophysiology of this condition is important for its prevention and management, given its responsibility for more than 25000 deaths in the United States. AAs are classified based on their location or morphology. various pathophysiologic pathways including inflammation, the immune system and atherosclerosis have been implicated in its development. Inflammatory markers such as transforming growth factor β, interleukin-1β, tumor necrosis factor-α, matrix metalloproteinase-2 and many more may contribute to this phenomenon. Several genetic disorders such as Marfan syndrome, Ehler-Danlos syndrome and Loeys-Dietz syndrome have also been associated with this disease. Recent years has seen the investigation of novel management of AA, exploring the implication of different immune suppressors, the role of radiation in shrinkage and prevention, as well as minimally invasive and newly hypothesized surgical methods. In this narrative review, we aim to present the new contributing factors involved in pathophysiology of AA. We also highlighted the novel management methods that have demonstrated promising benefits in clinical outcomes of the AA.

Multimodal Prehabilitation for Patients Undergoing Endovascular Aortic Aneurysm Repair Surgery: A Feasibility Study

BACKGROUND

Elective treatment options for aortic abdominal aneurysms include open repair or the less-invasive endovascular aortic aneurysm repair (EVAR). Recovery from EVAR is generally considered easier and faster than open repair. Despite this, EVAR remains a major procedure, and average return to preoperative quality of life is at least 3 months. The purpose of this study is to determine the safety and feasibility of multimodal prehabilitation, a multidisciplinary preoperative optimization intervention, in patients undergoing EVAR and its impact on perioperative functional capacity and quality of life.

METHODS

Candidates for EVAR with an infra-renal abdominal aortic aneurysm <7.5cm were invited to participate in a 6-week multimodal prehabilitation program that included (1) supervised and home-based exercise, (2) nutritional support, (3) psychosocial support, and (4) smoking cessation. Functional capacity and quality of life were assessed at baseline, before surgery and 6 weeks postoperatively. Recruitment rate, safety, and compliance were also assessed.

RESULTS

A total of 24 patients were included, 17 males (70%) and 7 females (30%). No adverse events occurred during the program. Compliance to each component of the program (median [Q1-Q3]) was 66% [67] for supervised training, 100% [67] for home-based training, and 100% [100] for nutrition. The multimodal prehabilitation program elicited a significant increase in functional capacity and quality of life preoperatively.

CONCLUSION

Multimodal prehabilitation for patients awaiting EVAR is feasible and safe. Multimodal prehabilitation improves both functional capacity and quality of life preoperatively. Further research is needed to assess the impact of multimodal prehabilitation on postoperative quality of life and functional capacity.

CLINICAL IMPACT

Multimodal prehabilitation is safe and feasible in patients awaiting endovascular aneurysm repair. The importance of this finding is that multimodal prehabilitation can be safely delivered preoperatively in patients awaiting EVAR. Although further research is needed, multimodal prehabilitation seems to improve preoperative functional capacity and quality of life. This could have an impact for the future implementation of prehabilitation interventions in order to increase functional reserve and quality of life preoperatively so that this high-risk population can cope better with the surgical stress and return to their normal life faster postoperatively.

The Ongoing Evolution of Abdominal Aortic Surgery

Abdominal aortic surgery has witnessed significant paradigm shifts in recent years with the introduction of structured screening programs, as well as the evolution of endovascular aortic aneurysm repair (EVAR), which has allowed physicians to promptly identify and successfully treat an increasing number of patients, even including those previously considered unfit for open repair [...].

Quality of Life for Patients Receiving Elective Interventions for Abdominal Aortic Aneurysms

Objectives: Information on the quality of life of patients operated on for abdominal aortic aneurysm (AAA) is scarce. The objective of this study was to analyse these patients’ health-related quality of life (HRQoL). Materials and Methods: This was a cross-sectional observational study. Patients undergoing elective AAA surgery from January 2013 to December 2020 were included. The Spanish version of the SF-36 questionnaire was administered to participants one to sixty months after surgery. Results: During the study period, 178 patients underwent surgery for AAA, 109 (61.23%) had open abdominal aortic repair (AAR) and 69 (38.54%) had endovascular aneurysm repair (EVAR). Mortality before the month of surgery was higher among those treated by AAR than EVAR (2.7% and 1.45%, respectively), while late mortality was higher in the EVAR group than in the AAR group (11.5% and 2.7%, respectively). In the late postoperative period, 12.5% of patients who underwent AAR presented complications compared to 25% of those treated with EVAR. The questionnaire was administered to 151 patients (91 AAR and 60 EVAR patients). The AAR patients compared to the EVAR patients had significantly higher mean scores on the health scales of the SF-36 questionnaire in Physical Function (p = 0.001), Vitality (p = 0.003), General Health (p = 0.37), Social Function (p = 0.023) and Mental Health (p = 0.006). Scores on the Mental Summary Component were significantly higher in the AAR group (p = 0.026). Conclusions: The group of patients treated with AAR showed the highest average scores on the scales of the SF-36 questionnaire in Physical Function, Vitality, General Health and Mental Health. The worst result was found in the Social Function scale for EVAR patients and was related to a higher rate of late complications.