Questions remain about quality of life after abdominal aortic aneurysm repair

Introduction: Morbidity and mortality have traditionally been used as key markers of surgical outcome. However, as complication rates associated with abdominal aortic aneurysm (AAA) repair decrease, subjective measures, such as quality of life (QOL), are increasingly recognized as important indicators of treatment efficacy and quality of care. This review presents the existing evidence relating to QOL changes in patients undergoing AAA repair by open repair (OR) and endovascular techniques (EVAR) and challenges current misconceptions about the relative effect of these two procedures. Methods: A comprehensive literature search was performed to identify studies relating to QOL or health status in AAA repair. Quality of included studies was assessed according to Scottish Intercollegiate Guidelines Network methodology. Results: Twenty-three studies satisfied the inclusion criteria. Preoperative QOL in AAA patients has been previously suggested as being worse than that of the general population, that OR patients have a worse QOL in the early postoperative period, and that EVAR patients have a worse QOL in the longer term. None of these assertions is uniformly supported in the literature. From the existing evidence, no clear conclusions can be drawn about the relative QOL benefits of OR vs EVAR. Conclusions: There are a paucity of good-quality data relating to health status and QOL in patients undergoing AAA repair. Little is known about the prevalence of preoperative or postoperative symptoms and the degree to which these influence patient well-being. Further investigation is needed to clarify health status and QOL changes in these patients and allow clinicians to make targeted improvements in practice. (J Vasc Surg 2012;56:520-7.)