Implications of Preoperative Arterial Stiffness for Patients Treated with Endovascular Repair of Abdominal Aortic Aneurysms

Overview

Journal JVS Vasc Sci

Specialty Cardiology & Vascular Diseases

Date 2024 Dec 16

PMID 39677517

Authors

Carly Thaxton

Masaki Kano

Daniel Mendes-Pinto

Tulio Pinho Navarro

Toshiya Nishibe

Alan Dardik

Affiliations

Soon will be listed here.

Abstract

Arterial stiffening is associated with adverse cardiovascular patient outcomes; stiffness may also be associated with postsurgical events and has been suggested to be a fundamental mechanism in the pathogenesis of aortic aneurysms. Although open repair of aneurysms decreases aortic stiffness, implantation of a rigid endograft is associated with increased aortic stiffness after endovascular aneurysm repair (EVAR). This review provides an overview of aortic wall physiology and the contemporary understanding of aortic stiffness and its implications for patients undergoing abdominal aortic aneurysm repair. Recent data suggests that increased central arterial stiffness, estimated preoperatively using the pulse wave velocity (PWV), may predict aneurysm sac behavior after EVAR, with elevated preoperative PWV associated with less sac shrinkage, and even sac enlargement, after EVAR. With the development of several simple noninvasive methods to measure PWV, such as brachial-ankle PWV and single cuff brachial oscillometry, there may be a role for monitoring ambulatory PWV to predict outcomes after EVAR. Additionally, because aortic stiffness is associated with adverse cardiovascular outcomes, and EVAR increases aortic stiffness, assessment of aortic stiffness before aortic interventions may help to guide therapeutic decisions as well as surveillance protocols, leading to optimized patient outcomes.

References

Lakatta E, Wang M, Najjar S . Arterial aging and subclinical arterial disease are fundamentally intertwined at macroscopic and molecular levels. Med Clin North Am. 2009; 93(3):583-604, Table of Contents. PMC: 2943242. DOI: 10.1016/j.mcna.2009.02.008. View

Mulvany M, Aalkjaer C . Structure and function of small arteries. Physiol Rev. 1990; 70(4):921-61. DOI: 10.1152/physrev.1990.70.4.921. View

Behmoaras J, Slove S, Seve S, Vranckx R, Sommer P, Jacob M . Differential expression of lysyl oxidases LOXL1 and LOX during growth and aging suggests specific roles in elastin and collagen fiber remodeling in rat aorta. Rejuvenation Res. 2008; 11(5):883-9. DOI: 10.1089/rej.2008.0760. View

Luzardo L, Lujambio I, Sottolano M, da Rosa A, Thijs L, Noboa O . 24-h ambulatory recording of aortic pulse wave velocity and central systolic augmentation: a feasibility study. Hypertens Res. 2012; 35(10):980-7. DOI: 10.1038/hr.2012.78. View

Del Giorno R, Troiani C, Gabutti S, Stefanelli K, Gabutti L . Comparing oscillometric and tonometric methods to assess pulse wave velocity: a population-based study. Ann Med. 2020; 53(1):1-16. PMC: 7877928. DOI: 10.1080/07853890.2020.1794538. View

Speelman L, Schurink G, Bosboom E, Buth J, Breeuwer M, van de Vosse F . The mechanical role of thrombus on the growth rate of an abdominal aortic aneurysm. J Vasc Surg. 2009; 51(1):19-26. DOI: 10.1016/j.jvs.2009.08.075. View

Belz G . Elastic properties and Windkessel function of the human aorta. Cardiovasc Drugs Ther. 1995; 9(1):73-83. DOI: 10.1007/BF00877747. View

Takeda Y, Sakata Y, Ohtani T, Tamaki S, Omori Y, Tsukamoto Y . Endovascular aortic repair increases vascular stiffness and alters cardiac structure and function. Circ J. 2013; 78(2):322-8. DOI: 10.1253/circj.cj-13-0877. View

Bastos Goncalves F, Baderkhan H, Verhagen H, Wanhainen A, Bjorck M, Stolker R . Early sac shrinkage predicts a low risk of late complications after endovascular aortic aneurysm repair. Br J Surg. 2014; 101(7):802-10. PMC: 4164270. DOI: 10.1002/bjs.9516. View

10.

Arenas Azofra E, Alvarez Marcos F, Fernandez Prendes C, Mosquera Rey V, Iglesias Iglesias C, Zanabili Al-Sibbai A . Predictive Factors of Aneurysm Sac Growth in Patients with a Type II Endoleak in the First Post-EVAR Control. Ann Vasc Surg. 2020; 68:245-251. DOI: 10.1016/j.avsg.2020.02.040. View

11.

Weiss W, Gohlisch C, Harsch-Gladisch C, Tolle M, Zidek W, van der Giet M . Oscillometric estimation of central blood pressure: validation of the Mobil-O-Graph in comparison with the SphygmoCor device. Blood Press Monit. 2012; 17(3):128-31. DOI: 10.1097/MBP.0b013e328353ff63. View

12.

Kadoglou N, Moulakakis K, Papadakis I, Ikonomidis I, Alepaki M, Lekakis J . Changes in aortic pulse wave velocity of patients undergoing endovascular repair of abdominal aortic aneurysms. J Endovasc Ther. 2012; 19(5):661-6. DOI: 10.1583/JEVT-12-3916MR.1. View

13.

Pukaluk A, Wittgenstein A, Leitinger G, Kolb D, Pernitsch D, Schneider S . An ultrastructural 3D reconstruction method for observing the arrangement of collagen fibrils and proteoglycans in the human aortic wall under mechanical load. Acta Biomater. 2022; 141:300-314. DOI: 10.1016/j.actbio.2022.01.036. View

14.

Ugajin A, Iwakoshi S, Ichihashi S, Inoue T, Nakai T, Kishida H . Prediction of Abdominal Aortic Aneurysm Growth After Endovascular Aortic Repair by Measuring Brachial-Ankle Pulse Wave Velocity. Ann Vasc Surg. 2021; 81:163-170. DOI: 10.1016/j.avsg.2021.08.056. View

15.

Wu W, Xie M, Qiu H . The Progress of Advanced Ultrasonography in Assessing Aortic Stiffness and the Application Discrepancy between Humans and Rodents. Diagnostics (Basel). 2021; 11(3). PMC: 8001300. DOI: 10.3390/diagnostics11030454. View

16.

Houbballah R, Majewski M, Becquemin J . Significant sac retraction after endovascular aneurysm repair is a robust indicator of durable treatment success. J Vasc Surg. 2010; 52(4):878-83. DOI: 10.1016/j.jvs.2010.04.069. View

17.

Wassertheurer S, Kropf J, Weber T, van der Giet M, Baulmann J, Ammer M . A new oscillometric method for pulse wave analysis: comparison with a common tonometric method. J Hum Hypertens. 2010; 24(8):498-504. PMC: 2907506. DOI: 10.1038/jhh.2010.27. View

18.

van Herwaarden J, Muhs B, Vincken K, van Prehn J, Teutelink A, Bartels L . Aortic compliance following EVAR and the influence of different endografts: determination using dynamic MRA. J Endovasc Ther. 2006; 13(3):406-14. DOI: 10.1583/06-1848.1. View

19.

Hametner B, Wassertheurer S, Kropf J, Mayer C, Eber B, Weber T . Oscillometric estimation of aortic pulse wave velocity: comparison with intra-aortic catheter measurements. Blood Press Monit. 2013; 18(3):173-6. DOI: 10.1097/MBP.0b013e3283614168. View

20.

Hall M, Protack C, Assi R, Williams W, Wong D, Lu D . Metabolic syndrome is associated with type II endoleak after endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2013; 59(4):938-43. PMC: 3966942. DOI: 10.1016/j.jvs.2013.10.081. View