Changes Of Brachial-ankle Pulse Wave Velocity Following Endovascular Aneurysm Repair Associated With Aortic Stiffness
Ryo Kanamoto, Hiroyuki Otsuka, Tohru Takaseya, Shinichi Nata, Seiji Onitsuka, Shinichi Hiromatsu, Hidetoshi Akashi, Hiroyuki Tanaka.
Department of Surgery, Kurume University School of Medicine, Kurume-city, Fukuoka, Japan.
Objective: Endovascular aneurysm repair (EVAR) has widely spread for treatment of abdominal aortic aneurysm. However, EVAR might increase the aortic stiffness, which was considered as a risk factor for future cardiovascular events in recent several reports. We evaluated the change of aortic stiffness after EVAR and its effect on mid-term cardiovascular event.Methods: We enrolled 126 patients who underwent primary EVAR between January 2013 and August 2017 at Kurume University hospital. Brachial-ankle pulse wave velocity (baPWV) data were collected before and 1 week after EVAR. The baPWV was evaluated by the mean baPWV values of both lower limbs. We evaluated the change of aortic stiffness (baPWV), risk factor for increased aortic stiffness post EVAR, and the mid-term outcomes compared the patients with worsened baPWV (increase more than 200 cm/s post EVAR) and the patients with not worsened baPWV.Results: The mean age was 76.4 ± 7.5 years. The mean observation period was 18.8 ± 16.3 months. The postoperative baPWV (mean; 2066 ± 575 cm/s) was significantly increased compared to the preoperative baPWV (mean; 1880 ± 396cm/s, P < 0.0001). 54 patients were worsened baPWV more than 200 cm/s following EVAR. The multivariate analysis identified an age of 80 years or more (OR: 2.23; 95% CI: 1.03-4.91; P = 0.041) and chronic kidney disease (OR: 9.88; 95% CI: 2.48-66.6; P = 0.0006) as independent risk factors of worsened baPWV. 17 patients experienced cardiovascular events, including the expansion of thoracic or abdominal aortic aneurysm, central nervous system disorder, acute heart failure, etc. during the observation period. However, there were no statistically significant differences in the cardiovascular event-free rate of patients with worsened baPWV during the study period. Conclusions: Our results show that EVAR increase aortic stiffness in the acute phases, especially in the elderly and patients with a kidney disease. We could not find out the harmful effects of increased aortic stiffness on future cardiovascular events in mid-term period. Longer follow up data in a larger population are required to clarify the effect of increased aortic stiffness indicated by baPWV on later cardiovascular events.
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