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Evaluation Of Aortic Stiffness: Assessing Influential Risk Factors And Central Hemodynamic Parameters In Patients Undergoing Endovascular Aortic Repair
Dora Babocs, MD
1, Tanbir A. Mohammed, MD
2, Steven Maximus, MD
1, Lucas R. Kanamori, MD
1, Titia Sulzer, BSc
1, Thomas Mesnard, MD
3, Andrea Vacirca, MD PhD
4, Emanuel R. Tenorio, MD PhD
1, Bruno P. Schmid, MD
1, Guilherme B. Lima, MD
5, Gustavo S. Oderich, MD
1, Siddharth Prakash, MD PhD
6.
1Advanced Aortic Research Program, Departments of Cardiothoracic & Vascular Surgery and Diagnostic Imaging and Interventional Radiology, McGovern Medical School, University of Texas Health Houston, Houston, TX, USA,
2Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States, Houston, TX, USA,
3Service de Chirurgie Vasculaire, Centre de l'Aorte, CHU Lille, Lille, France,
4Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy,
5Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA,
6Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA.
OBJECTIVE: Aortic biomechanical properties such as impedance, stiffness, or pulse wave velocity (PWV) frequently change after endovascular aortic repair (EVAR), but the underlying causes are not known. PWV is an independent risk factor for cardiovascular mortality in other contexts. The goal of this collaborative study was to identify surgical and medical factors that are correlated with changes in PWV after EVAR.
METHODS: Data were abstracted from clinical records of consecutive patients who underwent Fenestrated-Branched EVAR (FB-EVAR) at our institution between 2021-2023. Pre- and post-operative PWV measurements were performed using SphygmoCor XCEL. Individual variables were analyzed using descriptive statistics.
RESULTS: Out of one hundred patients, seventy percent of the cohort experienced a statistically significant (p<0.001) increase in PWV (7.8 to 11.0 m/s) immediately after FB-EVAR, while PWV decreased in thirty percent of the cohort (9.4 to 7.8 m/s). The characteristics of these two groups were not significantly different. Age, sex, peripheral arterial disease, CV risk factors, pre- and post-operative laboratory results, prescribed medications, 30-day surgical outcomes, and the proportions of individuals who had previous EVAR or open aortic procedures were similar between groups. The proportion of patients who had >40% aortic coverage was nonsignficantly higher (23% vs 11%, p=0.2) in the group with increased PWV.
CONCLUSIONS: PWV varies dramatically after endovascular aortic interventions and is independent of known predictive variables. We were unable to determine the underlying causes of variable PWV responses to FB-EVAR procedures despite examining extensive surgical and medical risk factors that may influence aortic stiffness. Follow up studies to determine if PWV is an independent predictor of adverse outcomes after EVAR are in progress.
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