Differential Effects of Stent-Graft Fabrics on Arterial Stiffness in Patients Undergoing Endovascular Aneurysm Repair

Kadoglou, Nikolaos P.E.; Moulakakis, Konstantinos G.; Papadakis, Ioannis; Ikonomidis, Ignatios; Alepaki, Maria; Spathis, Aris; Karakitsos, Petros; Lekakis, John; Liapis, Christos D.

doi:10.1583/14-4772mr.1

Cited by 69 publications

(41 citation statements)

References 38 publications

(44 reference statements)

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“…A), suggesting potentially different mechanisms of healing in polyester and pericardial patches. Polyester is noncompliant compared to other commonly implanted vascular biomaterials, and accordingly may support less neoendothelialization …”

Section: Discussionmentioning

confidence: 99%

Polyester vascular patches acquire arterial or venous identity depending on their environment

Bai

Guo

et al. 2017

J Biomedical Materials Res

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Polyester is commonly used in vascular surgery for patch angioplasty and grafts. We hypothesized that polyester patches heal by infiltration of arterial or venous progenitor cells depending on the site of implantation. Polyester patches were implanted into the Wistar rat aorta or inferior vena cava and explanted on day 7 or 30. Neointima that formed on polyester patches was thicker in the venous environment compared to the amount that formed on patches in the arterial environment. Venous patches had more cell proliferation and greater numbers of VCAM-positive and CD68-positive cells, whereas arterial patches had greater numbers of vimentin-positive and alpha-actin-positive cells. Although there were similar numbers of endothelial progenitor cells in the neointimal endothelium, cells in the arterial patch were Ephrin-B2- and notch-4-positive while those in the venous patch were Eph-B4- and COUP-TFII-positive. Venous patches treated with an arteriovenous fistula had decreased neointimal thickness; neointimal endothelial cells expressed Ephrin-B2 and notch-4 in addition to Eph-B4 and COUP-TFII. Polyester patches in the venous environment acquire venous identity, whereas patches in the arterial environment acquire arterial identity; patches in the fistula environment acquire dual arterial-venous identity. These data suggest that synthetic patches heal by acquisition of identity of their environment.

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Section: Discussionmentioning

confidence: 99%

Polyester vascular patches acquire arterial or venous identity depending on their environment

Bai

Guo

et al. 2017

J Biomedical Materials Res

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“…There are no sufficient data regarding aortic stiffness in patients with abdominal aortic aneurysms (AAA). PWV has been found higher in patients with AAA than healthy controls, possibly indicating decreased arterial compliance . Alterations in arterial wall composition and inflammation were proposed as contributors to the increased arterial stiffness in AAA .…”

Section: Introductionmentioning

confidence: 99%

“…PWV has been found higher in patients with AAA than healthy controls, possibly indicating decreased arterial compliance. 11 Alterations in arterial wall composition and inflammation were proposed as contributors to the increased arterial stiffness in AAA. 11,12 Furthermore, PWV was related, not only to the presence, but also to the severity of CAD in symptomatic CAD patients.…”

mentioning

confidence: 99%

“…11 Alterations in arterial wall composition and inflammation were proposed as contributors to the increased arterial stiffness in AAA. 11,12 Furthermore, PWV was related, not only to the presence, but also to the severity of CAD in symptomatic CAD patients. 8,13 In asymptomatic CAD patients, higher PWV values were also associated with the progression of coronary atherosclerosis assessed by either coronary artery calcium (CAC) score or luminal stenosis on computed tomography coronary angiography (CCTA).…”

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confidence: 99%

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Association of impaired arterial wall properties with the presence of coronary artery disease in patients with abdominal aortic aneurysms

Rafouli‐Stergiou

Ikonomidis

Katsiki

et al. 2020

J of Clinical Hypertension

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Pulse wave velocity (PWV) is a valid, clinically feasible marker of arterial stiffening, and a strong predictor of outcomes. The present study aimed to compare aortic elastic properties in patients with abdominal aortic aneurysms (AAA), with or without coronary artery disease (CAD), as well as healthy individuals. A total of 130 patients with AAA, eligible for interventional repair, and 30 healthy individuals, comprising the control group (HC), were enrolled. Presence of CAD was identified by coronary angiography. Aortic PWV (aPWV) was measured using the Arteriograph. aPWV was found considerably higher in AAA patients compared with HC group (11.5 ± 2.9 vs 7.3 ± 1.6 m/s, P < .001). Importantly, among patients with AAA, those with concomitant CAD (n = 41) had greater aPWV than those without CAD (12.5 ± 2.9 vs 11.0 ± 3.0 m/s, P = .03). In receiver operator curve (ROC) analysis, a value of aPWV above 12.8 m/s was identified to correlate with the presence of CAD in the AAA patient population. After adjustment for confounders, including hypertension which is one of the major risk factors for abdominal aneurysms, multivariate logistic regression analysis revealed that this aPWV cutoff remained independently associated with presence of CAD [odds ratio = 1.64, 95% confidence interval =1.19‐4.08, P = .03]. The coexistence of CAD and AAA is characterized by a greater arterial stiffness. This finding should be taken into consideration when selecting endovascular stents with more favorable elastic properties. Moreover, AAA patients with high aPWV (>12.8 m/s) are more likely to also have CAD, and this may be considered by vascular surgeons when evaluating patients' cardiovascular risk.

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“…However, no further details on stent morphology and structure parameters were presented in the aforementioned papers. Nikolaos [25] investigated the effects of different endograft fabric types, such as polyester and polytetrafluoroethylene, on pulse wave velocity (PWV), which is the main parameter of hemodynamics and reflects compliance indirectly. The results indicated that the stent graft incorporated with polyester showed greater PWV and lower compliance.…”

Section: Introductionmentioning

confidence: 99%

Compliance Study of Endovascular Stent Grafts Incorporated with Polyester and Polyurethane Graft Materials in both Stented and Unstented Zones

et al. 2016

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Compliance mismatch between stent graft and host artery may induce complications and blood flow disorders. However, few studies have been reported on stent graft compliance. This study aims to explore the deformation and compliance of stent graft in stented and unstented zones under three pressure ranges. Compliance of two stent grafts incorporated with polyurethane graft (nitinol-PU) and polyester graft (nitinol-PET) materials respectively were tested; the stents used in the two stent grafts were identical. For the circumferential deformation of the stent grafts under each pressure range, the nitinol-PET stent graft was uniform in both zones. The nitinol-PU stent graft was circumferentially uniform in the stented zone, however, it was nonuniform in the unstented zone. The compliance of the PU graft material was 15 times higher than that of the PET graft. No significant difference in compliance was observed between stented and unstented zones of the nitinol-PET stent graft regardless of the applied pressure range. However, for the nitinol-PU stent graft, compliance of the unstented PU region was approximately twice that of the stented region; thus, compliance along the length of the nitinol-PU stent graft was not constant and different from that of the nitinol-PET stent graft.

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Differential Effects of Stent-Graft Fabrics on Arterial Stiffness in Patients Undergoing Endovascular Aneurysm Repair

Abstract: Both endograft types increased PWV, while recipients of polyester covered stent-grafts showed greater PWV elevation. Further investigation will clarify the inflammatory response and the differential clinical impact of endograft types.

Cited by 69 publications

References 38 publications

Polyester vascular patches acquire arterial or venous identity depending on their environment

Polyester vascular patches acquire arterial or venous identity depending on their environment

Association of impaired arterial wall properties with the presence of coronary artery disease in patients with abdominal aortic aneurysms

Compliance Study of Endovascular Stent Grafts Incorporated with Polyester and Polyurethane Graft Materials in both Stented and Unstented Zones

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