Factors associated with preference of choice of aortic aneurysm repair in the PReference for Open Versus Endovascular repair of AAA (PROVE-AAA) study

Mark A. Eid, Jonathan A. Barnes, Kunal Mehta, Zachary Wanken, Jesse Columbo, Ravinder Kang, Karina Newhall, Vivienne Halpern, Joseph Raffetto, Panos Kougias, Peter Henke, Gale Tang, Leila Mureebe, Jason Johanning, Edith Tzeng, Salvatore Scali, David Stone, Bjoern Suckow, Eugeen Lee, Shipra AryaKristine Orion, Jessica O'Connell, Benjamin Brooke, Daniel Ihnat, Hasan Dosluoglu, Wei Zhou, Peter Nelson, Emily Spangler, Michael Barry, Brenda Sirovich, Philip Goodney

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Objective: Patients can choose between open repair and endovascular repair (EVAR) of abdominal aortic aneurysm (AAA). However, the factors associated with patient preference for one repair type over another are not well-characterized. Here we assess the factors associated with preference of choice for open or endovascular AAA repair among veterans exposed to a decision aid to help with choosing surgical treatment. Methods: Across 12 Veterans Affairs hospitals, veterans received a decision aid covering domains including patient information sources and understanding preference. Veterans were then given a series of surveys at different timepoints examining their preferences for open versus endovascular AAA repair. Questions from the preference survey were used in analyses of patient preference. Results were analyzed using χ2 tests. A logistic regression analysis was performed to assess factors associated with preference for open repair or preference for EVAR. Results: A total of 126 veterans received a decision aid informing them of their treatment choices, after which 121 completed all preference survey questions; five veterans completed only part of the instruments. Overall, veterans who preferred open repair were typically younger (70 years vs 73 years; P = .02), with similar rates of common comorbidities (coronary disease 16% vs 28%; P = .21), and similar aneurysms compared with those who preferred EVAR (6.0 cm vs 5.7 cm; P = .50). Veterans in both preference categories (28% of veterans preferring EVAR, 48% of veterans preferring open repair) reported taking their doctor's advice as the top box response for the single most important factor influencing their decision. When comparing the tradeoff between less invasive surgery and higher risk of long-term complications, more than one-half of veterans preferring EVAR reported invasiveness as more important compared with approximately 1 in 10 of those preferring open repair (53% vs 12%; P < .001). Shorter recovery was an important factor for the EVAR group (74%) and not important in the open repair group (76%) (P = .5). In multivariable analyses, valuing a short hospital stay (odds ratio, 12.4; 95% confidence interval, 1.13-135.70) and valuing a shorter recovery (odds ratio, 15.72; 95% confidence interval, 1.03-240.20) were associated with a greater odds of preference for EVAR, whereas finding these characteristics not important was associated with a greater odds of preference for open repair. Conclusions: When faced with the decision of open repair versus EVAR, veterans who valued a shorter hospital stay and a shorter recovery were more likely to prefer EVAR, whereas those more concerned about long-term complications preferred an open repair. Veterans typically value the advice of their surgeon over their own beliefs and preferences. These findings need to be considered by surgeons as they guide their patients to a shared decision.

Original languageEnglish
Pages (from-to)1556-1564
Number of pages9
JournalJournal of Vascular Surgery
Issue number6
StatePublished - Dec 2022


  • Abdominal aortic aneurysm
  • Decision aid
  • EVAR
  • Shared decision-making


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