Modifications in Aortic Stiffness After Endovascular or Open Aortic Repair: A Systematic Review and Meta-Analysis

Bissacco, Daniele; Conti, Michele; Domanin, Maurizio; Bianchi, Daniele; Scudeller, Luigia; Mandigers, Tim J.; Allievi, Sara; Auricchio, Ferdinando; Trimarchi, Santi

doi:10.1016/j.ejvs.2022.01.008

Cited by 16 publications

(18 citation statements)

References 39 publications

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“…This could also be linked to the analysis of the aortic stiffness, which results did not reach any statistical significance, even if a clear trend on parameters variation was observed. In fact, it is not in question the role that EVAR has on increasing aortic stiffness, but rather the clinical meaning in terms of cardiovascular complications 10,21,27 . These small variations between variables should also be observed considering the short temporal interval in analysis.…”

Section: Discussionmentioning

confidence: 99%

“…In fact, it is not in question the role that EVAR has on increasing aortic stiffness, but rather the clinical meaning in terms of cardiovascular complications. 10,21,27 These small variations between variables should also be observed considering the short temporal interval in analysis. Further studies with larger sample size and longer follow-up, including a control group, may help to validate the results and to evaluate the long-term impact of these variations.…”

Section: Limitationsmentioning

confidence: 98%

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Endovascular aortic repair impact on myocardial contractility: A prospective study

Spinella

Boschetti

Bauckneht

et al. 2023

Eur J Clin Investigation

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BackgroundThis study aimed to estimate if the altered sphygmic wave transmission may affect the left ventricular (LV) contractile function in patients undergoing endovascular aortic repair (EVAR).MethodsA prospective single‐centre study was carried out on consecutive patients undergoing EVAR for abdominal aortic aneurysm. A preoperative and 6‐month single photon emission computed tomography (SPECT) with arterial stiffness measurement were performed to evaluate variations in pressure wave curve and myocardial perfusion parameters.ResultsFrom 2018 to 2020 a total of 16 patients were included in the study. Among the parameters evaluated, we found a measurable reduction of the reflected wave transit time from pre‐ to postoperative period, for both stress (115.13 ± 7.2 ms–111.1 ± 7.0 ms, p = .08) and rest SPECT acquisitions (115.3 ± 6.2 ms–112.2 ± 5.6 ms, p = .1). Unidirectional increase of both LV end‐systolic volume (34 ± 9 mL–39 ± 8 mL, p = .02) and end‐diastolic volume (85 ± 34 mL–89 ± 29 mL, p = .6) was also observed. Lastly, the ratio between the end‐systolic pressure and the end‐systolic volume (maximal systolic myocardial stiffness) decreased from 3.6 ± 1.5 mmHg/mL to 2.66 ± .74 mmHg/mL (p = .03).ConclusionsOur data showed that EVAR induced an altered transmission of the sphygmic wave associated with an early LV contractile impairment.

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Section: Discussionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 98%

Endovascular aortic repair impact on myocardial contractility: A prospective study

Spinella

Boschetti

Bauckneht

et al. 2023

Eur J Clin Investigation

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“…According to the most recent meta-analysis from 2022, aortic stiffness is significantly increased after endovascular aortic repair but not after open surgery. Due to heterogeneity and the small number of included studies, reliable evidence is not yet available to draw further conclusions from this analysis [ 20 ]. The influence of different blood pressure values on PWV, even in the same patient, is not discussed.…”

Section: Discussionmentioning

confidence: 99%

“…EVAR and TEVAR appeared to result in a significant increase in PWV and thus aortic stiffness, which would be important because of an increased risk for cardiovascular events. However, the data were clearly limited by heterogeneity and the small number of available studies, so robust evidence is currently not available [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

Pulse Wave Velocity for Risk Stratification of Patients with Aortic Aneurysm

Schierling

Matzner

Apfelbeck

et al. 2022

JCM

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Background: Patients with an aortic aneurysm are at high cardiovascular risk. Pulse wave velocity (PWV) is used as a parameter for risk stratification but may be affected by aortic disease (AoD). This study aimed to investigate the dependence of PWV on treated or untreated AoD and to identify modifiable factors of PWV. Methods: The measurement of PWV with the Mobil-O-Graph was performed fully automatically in a collective of 381 patients (75.6% male and 24.4% female). Of all patients, 53.8% had nonaortic atherosclerotic vascular disease (AVD), 28.9% had treated AoD, and 17.3% had untreated AoD. Results: There was a statistically significant effect of age (R2 = 0.838) and current systolic blood pressure (SBP) on PWV (page corrected < 0.05). After correction for age, no statistically significant difference was found between the PWV of men and women, patients with different body weights or degrees of chronic kidney disease, diabetics and nondiabetics, and smokers and nonsmokers. Comparison between patients with nonaortic AVD and treated or untreated AoD revealed no statistically significant differences (PWVnonaortic AVD 10.0 ± 1.8 m/s, PWVtreated AoD 10.0 ± 1.5 m/s, PWVuntreated AoD 9.8 ± 1.6 m/s; page corrected > 0.05). Conclusions: PWV determined with the Mobil-O-Graph correlated with age and current SBP. Neither aortic disease versus nonaortic AVD, its treatment, nor other cardiovascular risk factors had a significant effect on PWV. Successful blood pressure control is crucial to avoid high PWV and thus an increase in cardiovascular events.

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“…However, the underlying principle has not changed substantially. Both the metallic skeleton and the graft materials reduce aortic compliance, causing a mismatch in the physio-mechanical properties between the native and stented aorta ( 18 ). The materials in current endografts are designed to enhance the durability of the graft and reduce the risk of endoleaks, but endografts have biomechanical properties that are several orders of magnitude stiffer than the native aorta ( 19 ).…”

Section: Discussionmentioning

confidence: 99%

The contemporary design of endovascular aneurysm stent-graft materials: PTFE versus polyester

2022

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Endovascular aneurysm repair of the abdominal aorta (EVAR) and of the thoracic aorta (TEVAR) have revolutionised therapeutic strategies in the management of aortic pathology, and endovascular repair is now an established and attractive alternative to open surgical repair (OSR) due to its superior short-term safety profile. However, opinions are divided regarding its long-term cost-effectiveness, which is reflected in the controversial NICE guidelines on abdominal aortic aneurysm (AAA) repair published in 2018, which advised against EVAR for elective aortic repair due to high secondary intervention rates and resultant associated costs. There is no doubt that OSR continues to have a valuable role to play in aortic repair, but it is not universally applicable, especially in older and sicker patients. Therefore, we should not dismiss EVAR and TEVAR without examining the reasons for long-term failure, and the most obvious starting point is stent graft material properties. Polytetrafluoroethylene (PTFE) and polyester are the two most common stent-graft materials; however, there has been no objective comparison of PTFE and polyester stent-graft post-procedural outcomes in EVAR and TEVAR, or even OSR. This lack of definitive data on different stent-graft materials and their configuration necessitates a comprehensive review to elucidate the post-procedural outcome in terms of endograft failure, cardiovascular events, and aortic-related mortality and morbidity.

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Modifications in Aortic Stiffness After Endovascular or Open Aortic Repair: A Systematic Review and Meta-Analysis

Cited by 16 publications

References 39 publications

Endovascular aortic repair impact on myocardial contractility: A prospective study

Endovascular aortic repair impact on myocardial contractility: A prospective study

Pulse Wave Velocity for Risk Stratification of Patients with Aortic Aneurysm

The contemporary design of endovascular aneurysm stent-graft materials: PTFE versus polyester

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