Effect of Abdominal Aortic Aneurysm Repair (Arterial Stiffening) on Pulse Wave Velocity and its Impact on Cardiovascular Hemodynamics

Abstract

Introduction: Aortic grafting and endografting has been reported to affect pulse wave velocity (PWV) and is considered a surrogate of arterial stiffness as well as a prognostic factor of cardiovascular morbidity. We aim to study potential correlations of PWV alterations post AAA repair using common aortic grafts with cardiovascular events, hypertension and kidney injury. Methods: Fifty-seven consecutive AAA patients from a single center were initially enrolled for a PWV analysis (Complior SP/ Analyze). Measurements were obtained pre-operatively, 1 week and 6 months post-operatively. Systolic blood pressure, carotid-radial (cr) PWV (central aortic stiffness), carotid-femoral (cf) PWV (peripheral aortic stiffness), cardiac events, medication adjustments and renal failure were recorded. Results: Ten open (6 Dacron, 4 ePTFE grafts) and 47 endovascular (OVATION stent-grafts), 49 elective and 8 urgent, AAA repairs were fully followed-up. Patient demographics included (mean values): age 69 years, aortic diameter 5.6 cm, BMI 27,6 kg/m2. All patients were men, 51 (92%) were smokers, 47 (83%) had hypertension, 15 (27%) Coronary Artery Disease, 6 (11%) diabetes mellitus, 33 (60%) dyslipidemia, 26 (47%) chronic obstructive pulmonary disease, 10 (18%) peripheral artery disease. We noticed an increase in c-f PWV (central aortic stiffness) (10.4,12.3,11.6; @preop, 1W and 6M postop, respectively, p< 0,001) and a decrease in c-r PWV (peripheral stiffness) (9.2,8.5,8.4, p< 0,01; respectively). 55% presented a rise greater than 10% of cf-PWV and 46% a decrease greater than 10% of cr-PWV. During the first 6 postoperative months, 3 (5%) needed adjustment of antihypertensive medical treatment presenting a greater than 20% rise of cf-PWV. 5 (8%) presented acute cardiovascular syndromes: 2 acute pulmonary oedema (greater than 20% rise of cf-PWV), 1 acute coronary syndrome (greater than 40% rise of cf-PWV), 1 aortic dissection (greater than 40% decrease of cr-PWV), 1 stroke (greater than 130% increase of cr-PWV). Five patients presented an acute kidney injury of which 3 presented a decrease of cf-PWV instead of an expected increase. Conclusion: PWV is an easy, reproducible and low cost examination, that can estimate modifications of aortic stiffness after AAA repair, either open or endovascular. This seems to have a subsequent effect on hypertension and major cardiovascular events. Current guidelines do not discriminate high risk subgroups for extensive cardiac follow up but thorough cardiac and renal consultation and lifetime follow may be crucial after AAA repair. More compliant new generation aortic grafts and endografts may decrease this effect. More studies are required to clarify the significance of PWV for AAA patients. Disclosure: Nothing to disclose