Quality of life after abdominal aortic aneurysm repair.
We have seen in the National breast screening programme that with
reasonable uptake of invitations, a massive increase in incidence of early
breast cancers (<1cm)(1) resulting in lead time bias. Tumours which
arguably, may never have come to fruition are associated with a large
increase in surgical intervention and morbidity. The same may become true
of abdominal aortic aneurysm screening.
The author(2) states that endovascular repair (EVAR) of aneurysms
carries a mortality of only 1.6%(3) and is undoubtedly a method that is
increasingly used. Of interest, Aljabri et al(4) found in it’s study of
quality of life after open and endovascular repair, that even though
endovascular repair is less invasive and associated with fewer
complications, patients reported lower quality of life scores 6 months
after surgery compared to those undergoing open repair. A reason for this
may be that those undergoing traditional repair feared for their lives and
were very grateful to be alive 6 months later, whilst those undergoing
endovascular repair possibly were not overly concerned about the 1.6% risk
of mortality and so were more focused on the morbidity associated with the
surgery.
Given the enormous increase in incidence of abdominal aortic
aneurysms that will occur with the screening programme, this finding of
low quality of life scores associated with EVAR may become a significant
health issue.
1. Moller et al. Over-diagnosis in breast cancer. BMJ. 2006 March
25;332:691-2.
2. S. Brearly. Should we screen for abdominal aortic aneurysm? BMJ
May 2008. 336:862.
3. EVAR trial participants. Patient fitness and survival following
abdominal aortic aneurysm repair: results from UK EVAR trials. Br J Surg
2007;94:709-16.
4. B Aljabri et al. Patient reported quality of life after abdominal
aortic aneurysm surgery; a prospective comparison of endovascular and open
repair. J Vasc Surg 2006 Dec;44(6);1182-87.
Rapid Response:
Quality of life after abdominal aortic aneurysm repair.
We have seen in the National breast screening programme that with reasonable uptake of invitations, a massive increase in incidence of early breast cancers (<1cm)(1) resulting in lead time bias. Tumours which arguably, may never have come to fruition are associated with a large increase in surgical intervention and morbidity. The same may become true of abdominal aortic aneurysm screening.
The author(2) states that endovascular repair (EVAR) of aneurysms carries a mortality of only 1.6%(3) and is undoubtedly a method that is increasingly used. Of interest, Aljabri et al(4) found in it’s study of quality of life after open and endovascular repair, that even though endovascular repair is less invasive and associated with fewer complications, patients reported lower quality of life scores 6 months after surgery compared to those undergoing open repair. A reason for this may be that those undergoing traditional repair feared for their lives and were very grateful to be alive 6 months later, whilst those undergoing endovascular repair possibly were not overly concerned about the 1.6% risk of mortality and so were more focused on the morbidity associated with the surgery.
Given the enormous increase in incidence of abdominal aortic aneurysms that will occur with the screening programme, this finding of low quality of life scores associated with EVAR may become a significant health issue.
1. Moller et al. Over-diagnosis in breast cancer. BMJ. 2006 March 25;332:691-2.
2. S. Brearly. Should we screen for abdominal aortic aneurysm? BMJ May 2008. 336:862.
3. EVAR trial participants. Patient fitness and survival following abdominal aortic aneurysm repair: results from UK EVAR trials. Br J Surg 2007;94:709-16.
4. B Aljabri et al. Patient reported quality of life after abdominal aortic aneurysm surgery; a prospective comparison of endovascular and open repair. J Vasc Surg 2006 Dec;44(6);1182-87.
Competing interests: None declared
Competing interests: No competing interests