Preferences for endovascular (EVAR) or open surgical repair among patients with abdominal aortic aneurysms under surveillance
Received 1 July 2008; accepted 12 September 2008.
Objectives
There is no evidence about patient preferences for treatment of abdominal aortic aneurysms (AAA) by endovascular aneurysm repair (EVAR) or open surgical repair (OSR). This study examined patient preferences for elective future aneurysm repair and factors that may influence such preferences.
Methods
Patients with small AAAs under ultrasound scan surveillance at two United Kingdom (UK) hospitals participated in a semi-structured telephone interview. Features of the two techniques were assessed with regard to their influence on the preferences of participants for EVAR or OSR, using a Likert scale. In addition, participants ranked the relative importance of 14 features against each other.
Results
Fifty-six out of 100 eligible participants (56%) completed the semi-structured telephone interview. Of those, 84% (47 patients) said they would prefer a future EVAR repair. Patients who expressed a preference for OSR were significantly younger. Risks of major organ failure and death were most commonly judged as important features in influencing patient preference (Likert scale score 5/5). Risk of death was also most frequently ranked above all other features. Postoperative morbidity and mortality were regarded by patients as more important than the need for surveillance and risk of long-term problems with EVAR. Type of incision and radiation exposure were both given low Likert scale scores of 1/5, and the risk of sexual dysfunction was most frequently ranked as the least important feature of either operation, out of 14 other features.
Conclusion
When presented with detailed information about EVAR and OSR, most patients with small aneurysms would prefer EVAR.
aDepartment of Vascular Surgery, Royal Devon and Exeter Hospital, Exeter, United Kingdom
cDepartment of Public Health and Primary Care, University of Cambridge, United Kingdom
dRoyal Devon and Exeter Hospital and Peninsula Medical School, Exeter, United Kingdom
Reprint requests: Rebecca J. Winterborn, MD, Department of Vascular Surgery, Royal Devon and Exeter Hospital, Barrack Road, Exeter EX2 5DW, United Kingdom
Competition of interest: none.
Additional material for this article may be found online at www.jvascsurg.org.
ABSTRACT