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Endovascular Aneurysm Repair Increases Aortic Stiffness And Central Aortic Pressure
Tohru Takaseya1, Seiji Onitsuka1, Hiroyuki Otsuka1, Hiroyuki Tanaka1, Hisashi Kai2, Hiroki Aoki3.
1The Department of Surgery, Kurume University Hospital, Fukuoka, Japan, 2Kurume Medical Center, Fukuoka, Japan, 3Cardiovascular research Institute, Kurume University of Medicine, Fukuoka, Japan.
OBJECTIVE: Endovascular aneurysm repair (EVAR) is considered as the predominant treatment for abdominal aortic aneurysms (AAA). Aortic stiffness has been proposed as a risk factor of cardiovascular events. However, the effects of EVAR on aortic stiffness remain to be clarified. Therefore, we evaluated the effect of EVAR on aortic stiffness by assessment of analyzed central aortic pressure pulse wave.
METHODS: We studied the effect of EVAR in 15 consecutive abdominal aortic aneurysm (AAA) patients (mean age = 75.8 years, M/F = 14/1). We performed trans-catheter measurement of aortic systolic blood pressure (aSBP) and aortic diastolic blood pressure (aDBP) at aortic root, and wave analysis based on an oscillometric method using a common cuff (ARCSolver) in AAA patients at both pre and post EVAR in general anesthesia during surgery. ARCSolver measured the systolic and diastolic pressure at brachial artery and determined pressures at the aortic level (aSBP and aDBP). The augmentation pressure (AP) and the augmentation index (AIx) were calculated from determined aortic pressures (Figure). The brachial-ankle pulse wave velocity (baPWV) data were also collected before and 1 week after EVAR.
RESULTS: Trans-catheter aSBP was significantly increased from 90.4 to 100.4 mmHg (p<0.05), but aDBP was not significantly changed from 48.0 mm Hg to 48.5 mm Hg after EVAR. Central aortic pressures determined by ARCSolver were similar with Trans-catheter measurements. aSBP increased from 86.9 to 98.1 mm Hg after EVAR (p<0.05), but aDBP was not significantly changed from 59.5 to 64.9 mm Hg. The AP was significantly elevated from 5.1 to 10.1 mm Hg, and the AIx was also significantly increased from 18.1 to 29.5 % (p<0.05). The baPWV was significantly elevated after EVAR compared with baseline from 1860 to 2193 cm/sec.
CONCLUSIONS: Our results show that EVAR increase aortic stiffness and aortic central pressure. The indication of EVAR is expanding to younger age, but we have to evaluate long-term results because increasing aortic stiffness might be a risk factor of cardiovascular events.
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