Patients’ Experiences of Recovery After Staged Aortic Repair: A Phenomenological Study

Introduction - An increasing number of patients with complex thoracoabdominal aortic pathologies are being treated by means of endovascular repair (EVAR) or with hybrid techniques involving both open and endovascular surgery. For extensive aortic treatment a staged strategy has proven advantageous and is often utilized. However, little is known on how these patients experience a prolonged course of repeated operations. The aim of this study was to explore how patients with complex thoracoabdominal aneurysms and aortic type B dissections experience to recover after a staged EVAR procedure, including adjunctive open surgery. Methods - Patients who had been operated on in a staged fashion between 2012 and 2017 were asked to participate. In-depth interviews were conducted and systematically analysed, using descriptive phenomenological method. Results - Six patients were included with a mean follow-up time of 2.5 years. The essence of the patients’ experience can be described as a necessary, overwhelming, hard and prolonged process with life changing consequences. Between the surgeries: The patients experienced expected and manageable tiredness, with not enough time available for recovery. Short-term after all surgeries: Tiredness, pain and complications, mostly neurological deficits, were experienced as overwhelming where the patients lost their identity, felt depressed and struggled to manage daily life one day to another. Long-term after all surgeries: The patients slowly and gradually regained their identity and accepted their new life, often with permanent setbacks and limitations. Conclusion – The findings indicate that patients with complex TAAA or aortic type B dissection operated on in a staged fashion struggle with various physical and psychological setbacks, even several years after their repair. It is important that the entire interprofessional team and the patient are aware of the high likelihood of significant and prolonged recovery process after staged EVAR for complex thoracoabdominal aortic pathologies. The patient’s recovery could be facilitated by continuous information and support throughout the entire process. Furthermore, there is a need to prospectively assess different aspects of these patients’ recovery processes, to identify those with impaired recovery after surgery, and establish proactive preventive strategies.