Determinants of Changes in Arterial Stiffness after Thoracic Endovascular Aortic Repair

Abstract

Aortic stent grafting can cause aortic stiffening and increase pulse wave velocity (PWV), which can potentially affect long-term cardiovascular outcomes. The aim of this study was to clarify the factors contributing to increases in PWV after thoracic endovascular aortic repair (TEVAR). We included 64 patients with thoracic aortic pathology (51 men; mean age, 73years) who underwent elective TEVAR, in this study. TEVAR was performed for degenerative aortic aneurysm (n=43) or aortic dissection (n=21), and the treatment length was 175±52mm. Brachial-ankle PWV (baPWV) was obtained before and 1week after TEVAR. Univariable and multivariable logistic regression analyses were used to determine the predictors of increases in baPWV of ≥100cm/sec after TEVAR. baPWV increased from 1,851±392cm/sec to 2,047±479cm/sec, and the change in baPWV (ΔbaPWV) was 195±339cm/sec (95% confidence interval, 111-280). Thirty-seven patients (58%) had ΔbaPWV ≥100cm/sec after TEVAR. In the multivariable analysis, in addition to Δheart rate and Δsystolic blood pressure, age (odds ratio, 1.21/year; 95% confidence interval, 1.05-1.40) and coronary artery disease (odds ratio, 12.0; 95% confidence interval, 1.20-121) were independent determinants of ΔbaPWV ≥100cm/sec after TEVAR, whereas ΔbaPWV ≥100cm/sec was not associated with treatment length or device type. TEVAR was associated with PWV progression, especially in older patients with coronary artery disease, whereas treatment length or device type was not a predictor of PWV progression after TEVAR.