Reservation of endovascular stent grafting for “at risk” patients - justified?

Abstract

Introduction: Open abdominal aortic aneurysm (AAA) repair carries significant morbidity and mortality. Endovascular AAA repair (EVAR) was introduced to improve the results of open surgery. However, increased cost and less durable outcome, with need for lifelong follow up and a high rate of re-intervention resulted in reservation of EVAR for “at risk” patients. We have previously demonstrated, decreased arterial stiffness and cardiac workload as assessed by applanation tonometry in patients post open AAA repair. The aim of this study was to evaluate ventricular workload in a cohort of patients undergoing EVAR and to compare the findings with those seen in open AAA repair. Methods: Patients undergoing elective open tube-graft (n = 12) and EVAR (n = 7) were studied pre-operatively and seven to ten days postoperatively. Assessement was in a temperature-controlled room following 15 minutes in the supine position using the non-invasive techniques of applanation tonometry and laser doppler fluximetry. Results:TABLE—ABSTRACT P84OpenEVARPre-op7–10 daysP-valuePre-op7–10 daysP-valueAugmentation35.5 (2.2)27.3 (4.1)<0.0527.8 (6.2)18.0 (5.0)<0.05End systolic p119.7 (3.3)110.2 (2.9)<0.05116.9 (4.6)106.6 (6.5)<0.05Mean systolic116.7 (2.8)111.6 (3.6)—115.0 (4.0)107.3 (6.1)—Mean diastolic96.5 (2.5)88.2 (2.5)<0.0598.5 (3.1)88.7 (4.9)<0.05Paired data compared with paired t-test, non-paired data with non-paired t-test, significance P < 0.05. Data expressed as mean (s.e.m.).Conclusions: No difference between the two groups were detected, suggesting that the stent component does not contribute significantly to vessel wall function directly and ventricular function indirectly. This may have implications for the design of new synthetic grafts and endovascular systems.