Journal of Vascular and Endovascular Therapy

Successful Incorporation of Patient Values and Preferences to Shared Decision-Making on Repair of Complex Thoraco-Abdominal Aortic Aneurysms

Background and purpose of paper: Complex Thoraco-Abdominal Aortic Aneurysms (TAAAs) confront both patients and providers with difficult treatment decisions. In recent decades, a Shared Decision-Making (SDM) approach has been advanced to achieve a patient-centered care. The case here illustrates, from the patient’s perspective, the successful incorporation of patient values and preferences to a shared decision-making on an Endovascular Aortic Aneurysm Repair (EVAR) for his complex thoraco-abdominal aortic aneurysms.

Case presentation: An 81 year old married, male, retired physician, a person of faith, felt a pulsating abdominal mass, which on angiograms revealed the presence of Crawford type IV complex thoraco-abdominal aneurysms.

The patient has felt well and has remained asymptomatic. Risk factors such as hypertension, hyperlipidemia, smoking, stress, and a family history of aneurysm were either absent or under-controlled. Both blood tests and a whole body scan revealed no evidence of infection. A nuclear cardiac stress test showed normal left ventricular perfusion. Three treatment options—watchful waiting, open surgery and EVAR—were available. Surgeon recommended EVAR.

Navigating Patient values and preferences were reflected in SDM in the assessments of short- and long-term risk factors; support and suggestion from friends, family and colleagues; scriptural support from persons of faith; assessment of projected post-treatment quality of life; rehabilitation plan; financial resources; planning for future goals; and consideration of personal moral and psycho-spiritual issues, including dreams and their interpretation.

Conclusion: SDM provides an egalitarian model of patient/clinician interaction, encourages patients taking an active role in decision-making, allows exploration of patient values and preferences that provide the context to the technical aspects of the treatment procedure in order to achieve a patient-centered care on the repair of complex TAAAs.

Author(s): Albert C Gaw, M.D*

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