Kato Takayoshi, Tamaki Mototsugu, Tsunekawa Tomohiro, Motoji Yusuke, Hirakawa Akihiro, Okawa Yasuhide, Tomita Shinji
Department of Cardiovascular Surgery, Gifu Heart Center, 4-14-4 Yabuta-minami, Gifu, Gifu, 500-8384, Japan.
Biostatistics and Bioinformatics Section, Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Aichi, Japan.
Heart Vessels. 2017 Aug;32(8):960-968. doi: 10.1007/s00380-017-0956-9. Epub 2017 Mar 17.
Open repair for infra-renal abdominal aortic and iliac artery aneurysms (AAAs) is a robust treatment. On the other hand, endovascular aneurysm repair (EVAR) has been widespread because of its less invasiveness. However, patients after EVAR frequently require postoperative radiographic examinations and may feel anxiety for their endoleaks. We prospectively evaluated Health-related Quality of Life of the patients with these two fashions using the 8-item Short Form (SF-8). From 2011 to 2013, 89 consecutive elective cases of AAAs were treated. They were prospectively divided into EVAR and open repair groups but not randomly. The exclusion criteria were as follows: perioperative status for other surgeries, infectious aneurysm, severely deteriorated conditions, and patients who cannot answer for these questionnaire or show their consent. The SF-8 questionnaire was completed through interviews preoperatively, and at 1, 3, 6, and 12 months after treatment. The SF-8 questionnaire was completed for 55 cases [EVAR group (ER): 25, open repair group (OR): 30]. There was no significant difference between these groups regarding patients' characteristics except congestive heart disease. The preoperative scores of the SF-8 were similar in both groups except physical function and social function, which were lower in ER (p < 0.05). There was no operative death in both groups. Operative duration and hospital stay in EVAR were significantly shorter than those in OR (p < 0.05). Follow-up rate at 1, 3, 6, and 12 months was 100, 100, 68.0, and 64.0% in ER, and 100, 90.0, 80.0, and 66.6% in OR, respectively. During follow-up, both groups had no AAAs associated death. Regarding changes of the SF-8 scales, there were some trends at physical component summary score (PCS) and mental component summary score (MCS) in ER. The PCS decreased at 1 month, gradually increased at 3 months, and levelled off until 12 months. The MCS increased at 1 and 3 months, but gradually went down and almost stayed at the same level as preoperative one at 12 months. In OR, PCS and MCS decreased at 1 month and after that increased gradually at 3 and 6 months, and stayed the same at 12 months. The MCS recovered to preoperative score earlier than the PCS. In this study, EVAR did not show any significant mental disturbance based on the SF-8 for 1-year comparing to open repair.
肾下腹主动脉瘤和髂动脉瘤的开放修复术是一种可靠的治疗方法。另一方面,血管内动脉瘤修复术(EVAR)因其微创性而得到广泛应用。然而,接受EVAR治疗的患者术后经常需要进行影像学检查,并且可能会因内漏而感到焦虑。我们使用8项简短形式(SF-8)前瞻性地评估了这两种治疗方式患者的健康相关生活质量。2011年至2013年,连续治疗了89例择期腹主动脉瘤病例。他们被前瞻性地分为EVAR组和开放修复组,但并非随机分组。排除标准如下:其他手术的围手术期状况、感染性动脉瘤、病情严重恶化以及无法回答该问卷或不同意参与的患者。SF-8问卷在术前以及治疗后1、3、6和12个月通过访谈完成。共对55例患者完成了SF-8问卷[EVAR组(ER):25例,开放修复组(OR):30例]。除充血性心脏病外,两组患者的特征无显著差异。除身体功能和社会功能外,两组SF-8的术前评分相似,ER组的这两项评分较低(p<0.05)。两组均无手术死亡病例。EVAR组的手术时间和住院时间明显短于OR组(p<0.05)。ER组在1、3、6和12个月时的随访率分别为100%、100%、68.0%和64.0%,OR组分别为100%、90.0%、80.0%和66.6%。随访期间,两组均无与腹主动脉瘤相关的死亡病例。关于SF-8量表的变化,ER组在身体成分汇总评分(PCS)和心理成分汇总评分(MCS)方面有一些趋势。PCS在1个月时下降,3个月时逐渐上升,直至12个月趋于平稳。MCS在1和3个月时上升,但逐渐下降,在12个月时几乎与术前水平持平。在OR组中,PCS和MCS在1个月时下降,之后在3和6个月时逐渐上升,在12个月时保持不变。MCS比PCS更早恢复到术前评分。在本研究中,与开放修复术相比,基于SF-8评估,EVAR在1年时未显示出任何明显的精神障碍。