Treatment Site Does Not Affect Changes in Pulse Wave Velocity but Treatment Length and Device Selection Are Associated With Increased Pulse Wave Velocity After Thoracic Endovascular Aortic Repair

Abstract

Background: Endovascular treatment of aortic aneurysm is associated with an increase in pulse wave velocity (PWV) after surgery. However, the effect of different types of endovascular devices on PWV at different sites of the thoracic aorta remains unclear.Objectives: The purposes of this study were (1) to investigate the changes in PWV after endovascular treatment of thoracic aortic aneurysm; (2) to evaluate whether there is a difference in the changes in PWV at different treatment sites; and (3) to evaluate the effect of treatment length on changes in PWV.Methods: From July 2008 to July 2021, 276 patients underwent endovascular treatment of the true thoracic aortic aneurysm. Of these patients, 183 patients who underwent preoperative and postoperative PWV measurement within 1 year of surgery were included in the study. The treatment length index was calculated by treatment length divided by the height of the patients.Results: Five different types of endovascular devices were used (Najuta, Kawasumi Laboratories, Inc., Tokyo, Japan; TAG, W.L. Gore & Associates, Inc., AZ, USA; Relay, Bolton Medical, Inc., FL, USA; Talent/Valiant, Medtronic, MN, USA; and Zenith, Cook Medical, IN, USA). There was no significant change in PWV in patients receiving Najuta (Before: 2,040 ± 346.8 cm/s vs. After: 2,084 ± 390.5 cm/s, p = 0.14). However, a significant increase was observed in other devices: TAG (Before: 2,090 ± 485.9 cm/s vs. After: 2,300 ± 512.1 cm/s, p = 0.025), Relay (Before: 2,102 ± 465.3 cm/s vs. After: 2,206 ± 444.4 cm/s, p = 0.004), Valiant (Before: 1,696 ± 330.2 cm/s vs. After: 2,186 ± 378.7 cm/s, p < 0.001), and Zenith (Before: 2,084 ± 431.7 cm/s vs. After: 2,321 ± 500.6 cm/s, p < 0.001). There was a significant increase in PWV in patients treated from aortic arch (Before: 2,006 ± 333.7 cm/s vs. After: 2,132 ± 423.7 cm/s, p < 0.001) and patients treated from descending thoracic aorta (Before: 2,116 ± 460.9 cm/s vs. After: 2,292 ± 460.9 cm/s, p < 0.001). Multivariate analysis showed that treatment site was not an independent factor associated with changes in PWV. However, Najuta (Coef −219.43, 95% CI −322.684 to −116.176, p < 0.001) and treatment index (Coef 147.57, 95% CI 24.826 to 270.312, p = 0.019) were independent factors associated with changes in PWV.Conclusion: Najuta did not show a significant increase in PWV, while other commercially available devices showed a significant increase. The treatment site did not have a different effect on PWV. However, the treatment length was an independent factor associated with an increase in PWV.

Arterial Stiffness and Aortic Aneurysmal Disease – A Narrative Review

“… 32 In addition, it was demonstrated more recently that treatment length was an independent factor related to PWV increase. 35 The same study also showed that treatment site as a sole factor did not have a different effect on PWV.…”

“…The review identified 10 studies (Table 3) reporting the influence of thoracic endografts, following TEVAR, on arterial stiffness. [27][28][29][30][31][32][33][34][35][36] Most studies on TEVAR utilized PWV to measure arterial stiffness. 27,28,30,33,35 In 2017, PWV was used for measuring the arterial stiffness in patients following TEVAR for descending thoracic aorta disease, showing remarkable increase 6 months postoperatively.…”

“…[27][28][29][30][31][32][33][34][35][36] Most studies on TEVAR utilized PWV to measure arterial stiffness. 27,28,30,33,35 In 2017, PWV was used for measuring the arterial stiffness in patients following TEVAR for descending thoracic aorta disease, showing remarkable increase 6 months postoperatively. 27 Hori et al suggest that endoskeleton (stents are mounted inside graft fabric) stent-graft design may allow for aneurysm repair with minimal impact on PWV, thereby reducing the risk of end-organ damage following endovascular repair.…”

Study Protocol of a Prospective, Monocentric, Single-Arm Study Investigating the Correlation of Endograft Properties with Aortic Stiffness in Abdominal Aortic Aneurysm Patients Subjected to Endovascular Aortic Repair

“…Similarly, in their study, Hori et al revealed the idea that the selection of a specific device is related to increased PWV after TEVAR. Furthermore, Hori et al found that the treatment length of the thoracic aorta and the length of the endograft are independent factors that are positively correlated with an increase in PWV after TEVAR, although the treatment site does not have an independent effect on the PWV [29]. On the contrary, in their study, Yamashita et al found that the treatment length and device type were not predictors of an increase in the PWV after TEVAR [30].…”

Assessments of Perfusion, Blood Flow, and Vascular Structure in Ambulatory Subjects: Guidance for Translational Research Scientists

“…VP-1000 Plus vascular screening device 2 [356,323] VaSera VS-1500 vascular screening system 1 [353] BOSO-ABI System 100 device 1 [359] BP-203RPEIII networked arterial stiffness detection device 1 [331] Mylab90 device 1 [125] Estimated PWV using age and mean blood pressure 1 [326] Omron Colin device 1 [325] Volume plethysmography device 1 [322] SOMNOscreen plus device 1 [349] DOI: 10.1159/000527765…”