Quality of life after abdominal aortic aneurysm repair: endovascular repair vs open repair

Quality of life after abdominal aortic aneurysm repair:

endovascular repair vs

open repair

A Systematic Review

Faculty of Medicine of Oporto University

Biostathistic and Medical Informatics Department

Introduction to Medicine – 1st Year

BRANDÃO, C, CARVALHO, M, COUTINHO, L, OLIVEIRA, J, PINHO, A, REBELO, R, RIBEIRO, E, RAMOS, P, SOUSA, J, VALE, S

2007/2008

IntroductionAbdominal aortic aneurysm:

•Focal enlargement of the abdominal aorta (usually envolving the infrarenal portion);

•Diameter >50% larger than normal or to >3 cm in its largest true transverse dimension1.

1. Hodges TC, Cronenwett J. Abdominal aortic and iliac artery aneurysms: clinical presentation, natural history and indications for intervention. In: Perler BA, Becker GJ, editors. Vascular Intervention: A Clinical Approach. New York: Thieme, 1998.

2, Allaqaband S, Slis J, Kazemi S, Bajwa T. Envovascular Treatment of Peripheral Vascular Disease. In: Curr Probl Cardiol, 2006

Indications for repair in patients with AAA include2 a diameter of 5 cm or larger (4.5 to 5.0 for women),

with a growth rate higher than 10mm/year.

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• The abdominal aortic aneurysm is one of the most studied because of his bigger incidence on the population: it affects about 5% ou 7% of world population;

• Generally, abdominal aortic aneurysm is 5 times more common in men than in women;

• In men, the process appears to begin at approximately age 40 years and reaches peak incidence from 75 to 79 years.

Introduction

Treatment

Endovascular surgeryOpen surgery

No treatment

Rupture leadind to death

Differences in the QOL after both surgical interventions

AAA

Aim

To compare quality of life of patients older than forty years after open or endovascular aortic repair of abdominal aneurysm.

Methods

• Systematic review searching in online medical databases:– Medline (Pubmed);– The Controlled Trials Register (The Cochrane

Library);– ISI Web of Knowledge

• Searching criteria: • From the earliest paper available until our

data acquisition (December 2007).

Venn Diagram

Methods

• Query

(“Abdominal Aortic Aneurysm” [MeSH] OR “AAA”) AND (“Quality of Life” OR “Health Care Quality Indicators” [MeSH] OR “QOL”) AND (“Endovascular Repair” OR “Endoluminal Repair” [MeSH] OR “EVAR”) AND (“Open Repair” OR “Surgery Repair”)

Initial tracing (inclusion):

Reading of abstracts and titles performed by five groups, composed by two reviewers.

Third reviewer: solving disagreement points.

Inclusion Criteria:

Compare quality of life after EVAR and open repair;

Include patients over forty years in the sample analysed;

Use SF-36 to evaluate quality of life parameters;

Mention the methods used and results;

Studies in humans;

Language: English;

Date of publication: From the earliest paper available until our data acquisition (December 2007).

Exclusion Criteria

• Studies with a follow-up period inferior to 1 month;

• Unobtainable full-text paper;• Use patients submitted to EVAR but unfit

to open.

Outcomes

Primary: the considered outcomes were the comparison of quality of life, between EVAR and open repair obtained from SF-36 total scores .

Secundary: comparison of singular parameters scores from SF-36, between EVAR and open.

Obtained six papers.

Flow Chart

Methods Description

Start

Define query:(“Abdominal Aortic Aneurysm” [MeSH] OR “AAA”) AND (“Quality of Life”

OR “Health Care Quality Indicators” [MeSH] OR “QOL”) AND (“Endovascular Repair” OR “Endoluminal Repair” [MeSH] OR “EVAR”) AND (“Open Repair” OR “Surgery Repair”)

Research on:

98 papers obtained (65 were not repeated between the medical search engines)

Read Titles and Abstracts by 5 groups of 2 Reviewers

Apply inclusion/exclusion criteria

Article excluded by at least 2 reviewers

Yes

Article included by at least 2 reviewers?

No

No

Consult a third reviewer3 papers

Yes

13Papers obtained

(2 paper non acessible)

Read full text by 5 groups of 2 reviewes

Apply inclusion/exclusion criteria

Article excluded by at least 2 reviewers

Yes

Article included by at least 2 reviewers?

No

No

Consult a third reviewer

Yes

6 papers obtained

Extract data to SPSS

Statistical analysis

End

Design data base

Paper WritingAdmission for

Publication

Preliminar Research

Pubmed Isi web of knowlegde Cochrane

36 papers obtained

52 papers obtained

10 papers obtained

Preliminar reading (28 papers)

15 excluded papers

5 papers excluded

Results

First month:

Paper 1: score difference of -1.90



QoL scores EVAR > QoL scores OPEN

Results

Third month:

Paper 3: score difference of 0.06



QoL scores OPEN > QoL scores EVAR

Results

Sixth month:





Results

One year:





Results

Until 2 months after the intervention:

QoL EVAR > QoL OPEN

At 2 months and beyond:

QoL EVAR < QoL OPEN

GANTT’S MAP

• Mapa_de_Gantt_-_Ta_2urm0.mpp

Discussion

Secondary outcome (still in progress)

Comparison of absolute scores:

1 month the OR group had significantly lower scores on physical function, social functioning, role-emotional, mental health, bodily pain and general health

6 months postoperatively physical function, social functioning, mental health, vitality, bodily pain and general health scores in the OR was significantly higher than in the EVAR group

12 months the physical-function, social-functioning, role-physical, mental health, vitality, bodily pain and general health scores were significantly higher in the OR group.

Discussion

Limitations:

the data provided by each one of the analysed papers was collected in different stages of post-operative period nevertheless they had few common points.

some papers include only SF-36 global scores and didn’t analyse individual score criteria making it difficult to perform an analysis focused on the differences between each domain (e.g. mental health, pain, …)

Conclusion

• Until 2 months after the intervention:– there is a small yet significante QoL

advantage of EVAR compared to OR;

• At 2 months and beyond:– patients reported a better QoL after OR

than after EVAR.

Evar... or Open.

That is the question!

Documents

Quality of life after abdominal aortic aneurysm repair: endovascular repair vs open repair