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Changes in Quality of Life and the Impact of Frailty After Fenestrated-Branched Endovascular Repair of Pararenal and Thoracoabdominal Aortic Aneurysms
Jay P Natarajan, Shivam Patel, Janelle F Barrera, Eric E Johnson, Sanjay V Wunnava, Rahul Mhaskar, Jean Bismuth, Dean J Arnaoutakis
University of South Florida, Tampa, FL
INTRODUCTION: Quality of life (QOL) metrics following infrarenal endovascular aortic aneurysm repair (EVAR) have been extensively studied, but QOL data after fenestrated-branched endovascular repair (F/BEVAR) for pararenal (PAA) and thoracoabdominal aortic aneurysms (TAAA) is more limited. As complex endovascular operative strategies become increasingly available, understanding the impact on postoperative health status is critical for optimal care delivery. This study evaluated changes in QOL over time and examined which variables influence QOL in patients undergoing F/BEVAR.
METHODS: Consecutive patients enrolled in a prospective, nonrandomized, single-center clinical trial using physician-modified F/BEVAR were included (June 2023-July 2024). QOL was evaluated using the EQ-5D instrument which measures 5 dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) using 5 severity scores and rates overall health (0-100). Patient responses were collected at baseline, 1-month, 6-month, and 12-month postoperatively. Preoperative characteristics, including the modified 5-item frailty index (MIF-5), operative variables, and postoperative outcomes were analyzed. The primary outcome measure was changes in EQ-5D scores over time. Generalized linear modeling with repeated measures was used to identify factors that influenced EQ-5D overall health over time.
RESULTS: Sixty-four patients were treated during the study period, 56 of whom had EQ-5D measurements at all time-points. Patients were predominantly elderly (74±6.1 years), Caucasian (n=57, 89%) men (n=45, 70%) who suffered from hypertension (n=58, 91%), coronary artery disease (n=28, 44%), chronic obstructive pulmonary disease (n=24, 38%), and chronic renal insufficiency (n=12, 19%). The mean MIF-5 score was 1.7±.83. Mean aneurysm size was 65±15.5mm with 27 (42%) patients classified as PAA, 24 (38%) extent IV TAAA, and 13 (20%) extent I, II, or V TAAA. The mean number of target arteries incorporated per patient was 3.9±0.5. Overall technical success was 100%, procedure time was 193±81 minutes, contrast volume was 98±25mL, and cumulative air kerma was 2,877±1,528mGy. Postoperative complications developed in 13 (20%) patients and 4 (6%) patients died within 30-days. The 2-year overall survival was 88%. All 5 EQ-5D dimensions declined 1-month after surgery, surpassed baseline values by 6-months, and then declined again at 12-months (Figure 1). The EQ-5D overall health score also declined after surgery, rebounded with time, and surpassed baseline levels by 12-months. In multivariate modeling, higher MIF-5 scores were significantly associated with poorer EQ-5D outcomes (p=.009, partial η²=.123), while age (p=.429, partial η²=.012) and postoperative complications (p=.241, partial η²=.026) were not (Figure 2).
CONCLUSIONS: Most dimensions that impact QOL including the overall health score, as assessed by the standardized EQ-5D, declined after F/BEVAR but surpassed baseline levels by 6-months. Frailty was associated with worse overall health status scores and should be strongly considered in preoperative patient selection. These prospectively collected QOL data can serve as an important benchmark for future clinical trials evaluating novel endovascular solutions for PAA/TAAA repair.
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