Biomarkers in EndoVascular Aneurysm Repair (EVAR) and Abdominal Aortic Aneurysm: Pathophysiology and Clinical Implications.

Francesco Stilo,Nunzio Montelione,Teresa Gabellini,Emanuele Verghi,Antonio Nenna,Vincenzo Catanese,Mohamad Jawabra,Massimo Chello,Francesco Spinelli,Francesco Alberto Codispoti

doi:10.3390/diagnostics12010183

Francesco Stilo, Nunzio Montelione + Show 8 more

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https://doi.org/10.3390/diagnostics12010183

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Abstract

Circulating biomarkers have been recently investigated among patients undergoing endovascular aortic aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA). Considering the plethora of small descriptive studies reporting potential associations between biomarkers and clinical outcomes, this review aims to summarize the current literature considering both the treated disease (post EVAR) and the untreated disease (AAA before EVAR). All studies describing outcomes of tissue biomarkers in patients undergoing EVAR and in patients with AAA were included, and references were checked for additional sources. In the EVAR scenario, circulating interleukin-6 (IL-6) is a marker of inflammatory reaction which might predict postoperative morbidity; cystatin C is a promising early marker of post-procedural acute kidney injury; plasma matrix metalloproteinase-9 (MMP-9) concentration after 3 months from EVAR might help in detecting post-procedural endoleak. This review also summarizes the current gaps in knowledge and future direction of this field of research. Among markers used in patients with AAA, galectin and granzyme appear to be promising and should be carefully investigated even in the EVAR setting. Larger prospective trials are required to establish and evaluate prognostic models with highest values with these markers.

Highlights

Abdominal aortic aneurysm (AAA) is a multifactorial disease and a potentially lifethreatening condition
Inflammatory cytokines and their regulatory activities have been extensively investigated in recent years, and a systematic review [3] concluded that IL-6 and IL-8 were involved in the post-implantation syndrome and their role is greater in open surgery
Circulating IL-6 is a marker of inflammatory reaction after Endovascular aortic aneurysm repair (EVAR) and might act as a useful predictor of postoperative morbidity

Summary

Introduction

Abdominal aortic aneurysm (AAA) is a multifactorial disease and a potentially lifethreatening condition. Short-term and long-term complications still hamper procedural success, and the most common complication is the residual perfusion of the aneurysmal sac (i.e., endoleak). Considering their frequency, patients undergo long-term surveillance screening with computed tomographic angiography or vascular ultrasound, which are limited by contrast administration or poor accuracy, respectively. Theof pathogenesis of abdominal aortic aneurysm (AAA) is by characterized by m degeneration, manifesting with elastic fiber fragmentation, collagen fiber disorganization, degeneration, manifesting with elastic fiber fragmentation, collagen fiber disorganiz and proteoglycan accumulation, as well as vascular smooth muscle cells (VSMC) loss [40].

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