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Prediction of Abdominal Aortic Aneurysm Growth After Endovascular Aortic Repair by Measuring Brachial-Ankle Pulse Wave Velocity

Published:November 05, 2021DOI:https://doi.org/10.1016/j.avsg.2021.08.056

      Background

      Although endovascular aortic repair (EVAR) has become the dominant therapeutic approach for abdominal aortic aneurysm (AAA), continued sac growth after EVAR remains a major concern and is still unpredictable. Since AAA formation is thought to arise from atherosclerotic vascular damage of the aortic wall, we hypothesize that the severity of atherosclerosis in the AAA wall may influence sac growth. Therefore, we investigated whether brachial-ankle pulse wave velocity (baPWV), a marker of atherosclerosis severity obtained by noninvasive automatic devices, can predict sac growth after EVAR.

      Methods

      The data from all patients who underwent elective EVAR for AAA at a single institution from January 2012 to March 2019 were reviewed. We extracted the baPWV before EVAR and divided patients into 2 groups according to the baPWV cut-off value identified by a classification and regression tree (CART). The primary outcome was significant sac growth, defined as an increment of 5 mm or more in aneurysm size after EVAR relative to the aneurysm size before EVAR. Cox regression analysis was performed to assess the potential predictors of sac growth.

      Results

      During the follow-up period, 222 consecutive patients underwent elective EVAR for AAA. Of these, 175 patients with a median follow-up period of 36 months were included. The baPWV values were classified as <1854 cm/s (Group 0) in 100 patients and ≥1854 cm/s (Group 1) in 75 patients according to the cut-off value identified by CART. During the follow-up period, 10 (10.0%) patients in Group 0 and 18 (24.0%) patients in Group 1 demonstrated significant sac growth (P = 0.021). Risk factors for significant sac growth included baPWV (hazard ratio [HR], 3.059; 95% confidence interval [CI], 1.41–6.64; P = 0.005), age (HR, 1.078; 95% CI, 1.01–1.16; P = 0.036), and persistent type II endoleak (HR, 3.552; 95% CI, 1.69–7.48; P < 0.001). Multivariate analysis revealed that baPWV remained a significant risk factor for sac growth after adjustment for age (HR, 2.602; 95% CI, 1.15–5.82; P = 0.02) and persistent type II endoleak (HR, 2.957; 95% CI, 1.36–6.43; P = 0.006).

      Conclusions

      The baPWV before EVAR was associated with significant sac growth after EVAR; thus, measuring the baPWV may be useful for assessing the risk of future sac growth in patients after EVAR.

      KEYWORDS

      Abbreviations:

      AAA (abdominal aortic aneurysm), ABI (ankle/brachial systolic blood pressure index), baPWV (brachial-ankle pulse wave velocity), CART (classification and regression tree), CI (confidence interval), CT (computed tomography), EVAR (endovascular aortic repair), HR (hazard ratio), IFU (instructions for use), PWV (pulse wave velocity)
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