The Effect of Revascularization on the Hemodynamic Profile of Patients with Infrarenal Aortic Occlusion

Abstract

Patients undergoing revascularization for infrarenal aortic occlusion (IAO) have been reported to present improved survival rates compared to those treated conservatively. Aim of this study was to investigate the hemodynamic changes induced after revascularization for IAO, as expressed with pulse wave velocity (PWV), augmentation index (Aix), augmentation pressure (AP), and pulse wave reflection coefficient (RC). Twelve patients underwent revascularization (9 aortobifemoral/aortobiiliac bypasses, 2 primary iliac stenting, and 1 hybrid procedure of unilateral aortoiliac stenting and crossover bypass). Calculation of hemodynamic parameters was performed in all patients preoperatively, at 1 month, and 1 year postoperatively. Pulse wave analysis was performed noninvasively with a novel validated brachial cuff-based automatic oscillometric device (Mobil-O-Graph; IEM, Stolberg, Germany). The estimated hemodynamic parameters were AIx, AP, RC, and PWV. Data were analyzed with the Friedman analysis of variance test. Aix decreased significantly at 1 month and further at 1 year postoperatively compared to preoperative values (24±11 and 17±13 vs. 34±13.5, respectively, P = 0.0006). AP decreased at 1 month and 1 year postoperatively compared to preoperative values (6.5 ± 4mm Hg and 8±6.5mm Hg vs. 13±12mm Hg, respectively, P = 0.045). RC decreased also at 1-month and 1-year postoperatively compared to preoperative values (62±5.5, 64±4.3 vs. 73±5.1, respectively, P = 0.002). However, changes in PWV were less prominent in this short-term postoperative period. Improved hemodynamic profile may theoretically contribute to the enhanced survival rates of these patients.