Long-term trends of quality of life in patients who undergo branched endovascular repair of pararenal and extent IV thoracoabdominal aortic aneurysms.

Abstract

Branched/fenestrated endovascular repair has become the mainstay treatment for thoracoabdominal aortic aneurysms (TAAAs) and pararenal aortic aneurysms (PAAs), yet little is known about its impact on patient quality of life (QoL). Long-term QoL trends in patients from the GORE EXCLUDER Thoracoabdominal Branch Endoprosthesis (TAMBE) multicenter, prospective pivotal trial were examined. In enrolled patients with TAAA or PAA who underwent TAMBE repair, the RAND 36-Item Health Survey (SF-36) was collected at baseline and at 1, 3, 6, and 12 months postoperatively. QoL physical and mental domain scores were compared from baseline to 1 year in the overall cohort and in subgroups of aneurysm type, frailty risk, occlusion, or reintervention. Patient characteristics were summarized using descriptive statistics and mean QoL scores were compared across timepoints using paired t tests. The cohort of 121 patients had a mean age 73 years, 82.8% were male (n = 101), 83.6% were White (n = 102); 59.0% (n = 72) had an extent IV TAAA, 41.3% (n = 50) had a PAA, and 77.7% (n = 94) were low frailty risk. In this analysis, 13.2% of patients (n = 16) experienced a branch vessel/graft occlusion and 14.0% (n = 17) underwent a reintervention. All QoL domain scores decreased at 1 month postoperatively, predominantly in physical health limitations (P < .0001). All QoL domains recovered toward baseline by 3 months postoperatively, but then gradually declined to 1 year; differences were statistically significant compared with baseline (P ≤ .05). There was no mean QoL domain score difference at any time point among the aneurysm type, branch occlusion, or reintervention subgroups (P ≥ .071). Physical domain scores between frailty risks were significant (P ≤ .05). Patients experienced an immediate decrease in all QoL domains after undergoing a TAMBE procedure, especially physical health, but recovered by 3 months postoperatively. Aneurysm extent, branch occlusion, and reinterventions did not impact QoL trends. Patients who underwent endovascular TAAA/PAA TAMBE repair exhibited a gradual decrease in health-related QoL over the long term. This result may be representative of the comorbid and elderly population who require such operations.