Annals of vascular surgery · 2026
Health-Related Quality of Life After Open and Endovascular Revascularization for Aortoiliac Occlusive Disease: A Prospective Cohort Study.
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Squizzato Francesco, Colacchio Elda Chiara, Menara Sabrina, Menegolo Mirko, Grego Franco, Piazza Michele, Antonello Michele
Аннотация
OBJECTIVES: To investigate the impact of open (OR) and endovascular repair (ER) on Health-Related Quality of Life (HRQOL) in patients treated for Aortoiliac Occlusive Disease (AIOD).
METHODS: We conducted a single-center prospective observational cohort study on consecutive patients treated by OR and ER for AIOD between January 2020 and July 2025. HRQOL was assessed using the 36-Item Short Form Health (SF-36) questionnaire at baseline, 1, 6, and 12 months. Physical (PCS) and Mental (MCS) Component Summary scores were compared between treatment groups using linear mixed-effects models with fixed effects for time, treatment, and their interaction. Linear regression models were used to assess factors associated with baseline HRQOL, while Firth's penalized logistic regression was used to evaluate factors associated with changes in HRQOL during follow-up.
RESULTS: Eighty-one patients were included: 20 (24.7%) underwent OR and 61 (75.3%) ER, for claudication (74.1%), rest pain (13.6%), or tissue loss (12.3%). No postoperative mortality occurred. Baseline PCS was associated with higher Rutherford class (p = .033) and TransAtlantic Inter-Society Consensus (TASC) lesion complexity (p = 0.02), while baseline MCS was associated with disease severity (p = .018) and comorbidities (p = .048). PCS improved significantly over time (p < 0.001), with a faster early improvement in the ER group (p for interaction= .005) especially within the first month from the procedure (p = .011). MCS also improved over time (p = .005), with no differences between groups. Early reintervention (p = .049 for PCS), late complications (p = .018 for PCS; p = .031 for MCS), chronic kidney disease (CKD) (p = .012 for PCS), coronary artery disease (CAD) (p = .014) and limb loss (p = .049 for PCS) were associated with reduced likelihood scores of HRQOL improvements at follow-up.
CONCLUSIONS: Both OR and ER were associated with significant improvements in HRQOL. ER provided faster early physical recovery, whereas mental health outcomes were comparable between treatment strategies. Patient characteristics and postoperative adverse events had a greater influence on HRQOL recovery than the revascularization strategy itself.
METHODS: We conducted a single-center prospective observational cohort study on consecutive patients treated by OR and ER for AIOD between January 2020 and July 2025. HRQOL was assessed using the 36-Item Short Form Health (SF-36) questionnaire at baseline, 1, 6, and 12 months. Physical (PCS) and Mental (MCS) Component Summary scores were compared between treatment groups using linear mixed-effects models with fixed effects for time, treatment, and their interaction. Linear regression models were used to assess factors associated with baseline HRQOL, while Firth's penalized logistic regression was used to evaluate factors associated with changes in HRQOL during follow-up.
RESULTS: Eighty-one patients were included: 20 (24.7%) underwent OR and 61 (75.3%) ER, for claudication (74.1%), rest pain (13.6%), or tissue loss (12.3%). No postoperative mortality occurred. Baseline PCS was associated with higher Rutherford class (p = .033) and TransAtlantic Inter-Society Consensus (TASC) lesion complexity (p = 0.02), while baseline MCS was associated with disease severity (p = .018) and comorbidities (p = .048). PCS improved significantly over time (p < 0.001), with a faster early improvement in the ER group (p for interaction= .005) especially within the first month from the procedure (p = .011). MCS also improved over time (p = .005), with no differences between groups. Early reintervention (p = .049 for PCS), late complications (p = .018 for PCS; p = .031 for MCS), chronic kidney disease (CKD) (p = .012 for PCS), coronary artery disease (CAD) (p = .014) and limb loss (p = .049 for PCS) were associated with reduced likelihood scores of HRQOL improvements at follow-up.
CONCLUSIONS: Both OR and ER were associated with significant improvements in HRQOL. ER provided faster early physical recovery, whereas mental health outcomes were comparable between treatment strategies. Patient characteristics and postoperative adverse events had a greater influence on HRQOL recovery than the revascularization strategy itself.