Open or Endovascular Repair for Abdominal Aortic Aneurysm—Would a Decision Aid Help?

Abstract

In this issue of JAMA Surgery, Eid et al 1 presented a randomized clinical study aimed to determine if a preconsultationadministered decision aid would affect a patient's choice between open or endovascular repair (EVAR) for abdominal aortic aneurysm. Their results showed that patients exposed to a decision aid were more likely to receive the repair they preferred. Interestingly, almost 45% of patients did not know their preference before the aid was administered, and 24% remained unsure afterward. All patients, irrespective of whether a decision aid was administered, were able to reach a decision after they consulted with a vascular surgeon. As expected, the majority of patients preferred EVAR over open repair. Very few patients who chose EVAR ultimately selected open repair, whereas more patients who chose open repair in the control group ultimately selected EVAR.The choice of open repair vs EVAR is complex, and as detailed in the study by Eid et al, 1 it involved detailed discussions between patients and the vascular surgeon who actually performed the repair. The decision aid provided good information on morbidity, hospital stay, and reintervention risk but without technical and anatomic details. The argument that EVAR is a new procedure or that the long-term results of EVAR are unknown seemed outdated because EVAR has been in existence for more than 30 years. In many centers, a computed tomography follow-up scan is no longer standard protocol. The intricacies and implications of surgery and techniques, or secondary interventions, is also beyond the discussion of a simple aid.

Different Methods of Endovascular Techniques in Management of Aorto-Iliac Occlusive Disease

“…During EVAR, a stent-graft is utilised to replace the inner lining of the aorta. A stent-graft is a steel skeleton wrapped in impermeable fabric that is placed into the femoral arteries under fluoroscopic supervision (9) .…”