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Moulakakis KG, Pitros CF, Theodosopoulos IT, Mylonas SN, Kakisis JD, Manopoulos C, Kadoglou NPE. Arterial Stiffness and Aortic Aneurysmal Disease - A Narrative Review. Vasc Health Risk Manag 2024; 20:47-57. [PMID: 38374913 PMCID: PMC10875171 DOI: 10.2147/vhrm.s410736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 02/02/2024] [Indexed: 02/21/2024] Open
Abstract
It has been documented that large-artery stiffness is independently associated with increased cardiovascular risk and may potentially lead to heart and kidney failure and cerebrovascular disease. A systematic review of studies investigating changes in arterial stiffness in patients undergoing endovascular repair of aortic disease was conducted. In addition, a review of the available literature was performed, analyzing findings from studies using the cardio-ankle vascular index (CAVI) as a marker of arterial stiffness. Overall, 26 studies were included in the present analysis. Our research revealed a high heterogeneity of included studies regarding the techniques used to assess the aortic stiffness. Aortic stiffness was assessed by pulse wave velocity (PWV), elastic modulus (Ep), and augmentation index (AI). Currently a few studies exist investigating the role of CAVI in patients having an aortic aneurysm or undergoing endovascular aortic repair. The majority of studies showed that the treatment of an abdominal aortic aneurysm (AAA) either with open repair (OR) or endovascular aortic repair (EVAR) reduces aortic compliance significantly. Whether EVAR reconstruction might contribute a higher effect on arterial stiffness compared to OR needs further focused research. An increase of arterial stiffness was uniformly observed in studies investigating patients following thoracic endovascular aortic repair (TEVAR), and the effect was more pronounced in young patients. The effects of increased arterial stiffness after EVAR and TEVAR on the heart and the central hemodynamic, and an eventual effect on cardiac systolic function, need to be further investigated and evaluated in large studies and special groups of patients.
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Affiliation(s)
| | - Christos F Pitros
- Department of Vascular Surgery, Patras University Hospital, University of Patras, Patras, Greece
| | - Ioannis T Theodosopoulos
- Department of Vascular Surgery, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyridon N Mylonas
- Department of Vascular and Endovascular Surgery, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, 50937, Germany
| | - John D Kakisis
- Department of Vascular Surgery, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos Manopoulos
- Biofluid Mechanics and Biomedical Engineering Laboratory, Fluids Section, School of Mechanical Engineering, National Technical University of Athens, Athens, Greece
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Pulse Wave Velocity for Risk Stratification of Patients with Aortic Aneurysm. J Clin Med 2022; 11:jcm11144026. [PMID: 35887789 PMCID: PMC9316234 DOI: 10.3390/jcm11144026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 07/04/2022] [Accepted: 07/11/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Patients with an aortic aneurysm are at high cardiovascular risk. Pulse wave velocity (PWV) is used as a parameter for risk stratification but may be affected by aortic disease (AoD). This study aimed to investigate the dependence of PWV on treated or untreated AoD and to identify modifiable factors of PWV. Methods: The measurement of PWV with the Mobil-O-Graph was performed fully automatically in a collective of 381 patients (75.6% male and 24.4% female). Of all patients, 53.8% had nonaortic atherosclerotic vascular disease (AVD), 28.9% had treated AoD, and 17.3% had untreated AoD. Results: There was a statistically significant effect of age (R2 = 0.838) and current systolic blood pressure (SBP) on PWV (page corrected < 0.05). After correction for age, no statistically significant difference was found between the PWV of men and women, patients with different body weights or degrees of chronic kidney disease, diabetics and nondiabetics, and smokers and nonsmokers. Comparison between patients with nonaortic AVD and treated or untreated AoD revealed no statistically significant differences (PWVnonaortic AVD 10.0 ± 1.8 m/s, PWVtreated AoD 10.0 ± 1.5 m/s, PWVuntreated AoD 9.8 ± 1.6 m/s; page corrected > 0.05). Conclusions: PWV determined with the Mobil-O-Graph correlated with age and current SBP. Neither aortic disease versus nonaortic AVD, its treatment, nor other cardiovascular risk factors had a significant effect on PWV. Successful blood pressure control is crucial to avoid high PWV and thus an increase in cardiovascular events.
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Holewijn S, Vermeulen JJM, van Helvert M, van de Velde L, Reijnen MMPJ. Validation of Central Pressure Estimation in Patients with an Aortic Aneurysm Before and After Endovascular Repair. Cardiovasc Eng Technol 2022; 13:265-278. [DOI: https:/doi.org/10.1007/s13239-021-00574-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 08/10/2021] [Indexed: 11/30/2023]
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Modifications in Aortic Stiffness After Endovascular or Open Aortic Repair: A Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg 2022; 63:567-577. [DOI: 10.1016/j.ejvs.2022.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 12/29/2021] [Accepted: 01/16/2022] [Indexed: 01/10/2023]
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Holewijn S, Vermeulen JJM, van Helvert M, van de Velde L, Reijnen MMPJ. Validation of Central Pressure Estimation in Patients with an Aortic Aneurysm Before and After Endovascular Repair. Cardiovasc Eng Technol 2021; 13:265-278. [PMID: 34585343 DOI: 10.1007/s13239-021-00574-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 08/10/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of this study was to investigate if non-invasive central pressure estimations are accurate in patients with an abdominal aortic aneurysm, before and after endovascular repair. Secondary evaluation was if measurement-accuracy was dependent on anatomical characteristics. METHODS Procedural invasive and non-invasive pressure-measurements were performed simultaneously both before and after endovascular repair in 20 patients with an infrarenal abdominal aortic aneurysm. Invasive catheter measurements were performed in the abdominal aorta. A tonometric device was used to perform non-invasive pressure-wave-analysis at the radial artery. A generalized transfer-function was used to generate an ascending aortic waveform for both measurements, allowing for direct comparison. RESULTS Pre-treatment the mean differences between methods were - 5.5 mmHg (p = .904), - 11.8 (p < .001), and - 7.2 mmHg (p = .124) for central systolic, diastolic, and mean pressure, respectively. The accuracy was dependent of aneurysm sac volume and intraluminal thrombus volume. Post-treatment limits of agreement were smaller for all pressure parameters compared to pre-treatment. The mean differences were 6.5 mmHg (p = .007), - 6.4 (p < .020), and 1.6 mmHg (p = .370) for central systolic, diastolic, and mean pressure, respectively. CONCLUSION In untreated AAA's the accuracy of non-invasive central pressure estimation was acceptable (mean difference between 5 and 10 mmHg) when compared to invasive pressures, but dependent of AAA characteristics. After EVAR the accuracy of central pressure estimation improved (reduction of 75% of the mean difference between pre and post measurements) TRIAL REGISTRATION NUMBER: NCT03469388; 3-5-2018.
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Affiliation(s)
- S Holewijn
- Vascular Center, Department of Surgery, Rijnstate, P.O. Box 9555, 6800 TA, Arnhem, The Netherlands.
| | - J J M Vermeulen
- Vascular Center, Department of Surgery, Rijnstate, P.O. Box 9555, 6800 TA, Arnhem, The Netherlands.,Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M van Helvert
- Vascular Center, Department of Surgery, Rijnstate, P.O. Box 9555, 6800 TA, Arnhem, The Netherlands.,MultiModality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - L van de Velde
- Vascular Center, Department of Surgery, Rijnstate, P.O. Box 9555, 6800 TA, Arnhem, The Netherlands.,MultiModality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - M M P J Reijnen
- Vascular Center, Department of Surgery, Rijnstate, P.O. Box 9555, 6800 TA, Arnhem, The Netherlands.,MultiModality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, The Netherlands
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Holewijn S, Vermeulen JJM, van Helvert M, van de Velde L, Reijnen MMPJ. Changes in Noninvasive Arterial Stiffness and Central Blood Pressure After Endovascular Abdominal Aneurysm Repair. J Endovasc Ther 2021; 28:434-441. [DOI: https:/doi.org/10.1177/15266028211007460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
Purpose: To evaluate the impact of elective endovascular aneurysm repair (EVAR) on the carotid-femoral pulse wave velocity (cfPWV) and central pressure waveform, through 1-year follow-up. Materials and Methods: A tonometric device was used to measure cfPWV and estimate the central pressure waveform in 20 patients with an infrarenal abdominal aortic aneurysm scheduled for elective EVAR. The evaluated central hemodynamic parameters included the central pressures, the augmentation index (AIx), and the subendocardial viability ratio (SEVR). AIx quantifies the contribution of reflected wave to the central systolic pressure, whereas SEVR describes the myocardial perfusion relative to the cardiac workload. Measurements were performed before EVAR, at discharge, and 6 weeks and 1 year after EVAR. Results: CfPWV was increased at discharge (12.4±0.4 vs 11.3±0.5 m/s at baseline; p=0.005) and remained elevated over the course of 1-year follow-up (6 weeks: cfPWV = 12.2±0.5 m/s; 1 year: cfPWV = 12.2±0.7 m/s, p<0.05). After an initial drop in systolic central pressure at discharge, all the central pressures increased thereafter up to 1 year, without significant differences compared with baseline. The same was observed for the AIx and SEVR. Conclusion: Endovascular aortic aneurysm repair caused an increase in pulse wave velocity compared with baseline, which remained elevated through 1 year follow-up, which may be related to an increased cardiovascular risk. However, no differences in central pressure, augmentation index, and subendocardial viability ration were observed during follow-up.
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Affiliation(s)
- Suzanne Holewijn
- Department of Surgery, Ziekenhuis Rijnstate, Arnhem, The Netherlands
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jenske J. M. Vermeulen
- Department of Surgery, Ziekenhuis Rijnstate, Arnhem, The Netherlands
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Majorie van Helvert
- Department of Surgery, Ziekenhuis Rijnstate, Arnhem, The Netherlands
- MultiModality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - Lennart van de Velde
- Department of Surgery, Ziekenhuis Rijnstate, Arnhem, The Netherlands
- MultiModality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - Michel M. P. J. Reijnen
- Department of Surgery, Ziekenhuis Rijnstate, Arnhem, The Netherlands
- MultiModality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, The Netherlands
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Holewijn S, Vermeulen JJM, van Helvert M, van de Velde L, Reijnen MMPJ. Changes in Noninvasive Arterial Stiffness and Central Blood Pressure After Endovascular Abdominal Aneurysm Repair. J Endovasc Ther 2021; 28:434-441. [PMID: 33834904 DOI: 10.1177/15266028211007460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate the impact of elective endovascular aneurysm repair (EVAR) on the carotid-femoral pulse wave velocity (cfPWV) and central pressure waveform, through 1-year follow-up. MATERIALS AND METHODS A tonometric device was used to measure cfPWV and estimate the central pressure waveform in 20 patients with an infrarenal abdominal aortic aneurysm scheduled for elective EVAR. The evaluated central hemodynamic parameters included the central pressures, the augmentation index (AIx), and the subendocardial viability ratio (SEVR). AIx quantifies the contribution of reflected wave to the central systolic pressure, whereas SEVR describes the myocardial perfusion relative to the cardiac workload. Measurements were performed before EVAR, at discharge, and 6 weeks and 1 year after EVAR. RESULTS CfPWV was increased at discharge (12.4±0.4 vs 11.3±0.5 m/s at baseline; p=0.005) and remained elevated over the course of 1-year follow-up (6 weeks: cfPWV = 12.2±0.5 m/s; 1 year: cfPWV = 12.2±0.7 m/s, p<0.05). After an initial drop in systolic central pressure at discharge, all the central pressures increased thereafter up to 1 year, without significant differences compared with baseline. The same was observed for the AIx and SEVR. CONCLUSION Endovascular aortic aneurysm repair caused an increase in pulse wave velocity compared with baseline, which remained elevated through 1 year follow-up, which may be related to an increased cardiovascular risk. However, no differences in central pressure, augmentation index, and subendocardial viability ration were observed during follow-up.
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Affiliation(s)
- Suzanne Holewijn
- Department of Surgery, Ziekenhuis Rijnstate, Arnhem, The Netherlands.,Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jenske J M Vermeulen
- Department of Surgery, Ziekenhuis Rijnstate, Arnhem, The Netherlands.,Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Majorie van Helvert
- Department of Surgery, Ziekenhuis Rijnstate, Arnhem, The Netherlands.,MultiModality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - Lennart van de Velde
- Department of Surgery, Ziekenhuis Rijnstate, Arnhem, The Netherlands.,MultiModality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - Michel M P J Reijnen
- Department of Surgery, Ziekenhuis Rijnstate, Arnhem, The Netherlands.,MultiModality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, The Netherlands
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Georgakarakos E, Argyriou C, Georgiadis GS, Lazarides MK. Pulse Wave Analysis after Treatment of Abdominal Aortic Aneurysms with the Ovation Device. Ann Vasc Surg 2017; 40:146-153. [DOI: 10.1016/j.avsg.2016.07.080] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/06/2016] [Accepted: 07/06/2016] [Indexed: 11/24/2022]
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Schoretsanitis N, Georgakarakos E, Argyriou C, Ktenidis K, Georgiadis GS. A critical appraisal of endovascular stent-grafts in the management of abdominal aortic aneurysms. Radiol Med 2017; 122:309-318. [DOI: 10.1007/s11547-017-0724-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 01/03/2017] [Indexed: 11/30/2022]
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Estimating the influence of aortic-stent grafts after endovascular aneurysm repair: Are we missing something? Med Hypotheses 2016; 97:26-30. [DOI: 10.1016/j.mehy.2016.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 09/02/2016] [Accepted: 10/06/2016] [Indexed: 11/23/2022]
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Georgakarakos E, Ioannou CV, Georgiadis GS, Storck M, Trellopoulos G, Koutsias S, Lazarides MK. The ovation abdominal stent graft for the treatment of abdominal aortic aneurysms: current evidence and future perspectives. Expert Rev Med Devices 2016; 13:253-62. [DOI: 10.1586/17434440.2016.1147949] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Georgakarakos E, Argyriou C, Georgiadis GS, Lazarides MK. Non-Invasive Pulse Wave Analysis in a Thrombus-Free Abdominal Aortic Aneurysm after Implantation of a Nitinol Aortic Endograft. Front Surg 2016; 2:68. [PMID: 26793712 PMCID: PMC4707224 DOI: 10.3389/fsurg.2015.00068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 12/17/2015] [Indexed: 11/13/2022] Open
Abstract
Endovascular aneurysm repair has been associated with changes in arterial stiffness, as estimated by pulse wave velocity (PWV). This marker is influenced by the medical status of the patient, the elastic characteristics of the aneurysm wall, and the presence of intraluminal thrombus. Therefore, in order to delineate the influence of the endograft implantation in the early post-operative period, we conducted non-invasively pulse wave analysis in a male patient with an abdominal aortic aneurysm containing no intraluminal thrombus, unremarkable past medical history, and absence of peripheral arterial disease. The estimated parameters were the systolic and diastolic pressure calculated at the aortic level (central pressures), PWV, augmentation pressure (AP) and augmentation index (AI), pressure wave reflection magnitude (RM), and peripheral resistance. Central systolic and diastolic pressure decreased post-operatively. PWV showed subtle changes from 11.6 to 10.6 and 10.9 m/s at 1-week and 1-month, respectively. Accordingly, the AI decreased from 28 to 14% and continued to drop to 25%. The AP decreased gradually from 15 to 6 and 4 mmHg. The wave RM dropped from 68 to 52% at 1-month. Finally, the peripheral resistance dropped from 1.41 to 0.99 and 0.85 dyn × s × cm−5. Our example shows that the implantation of an aortic endograft can modify the pressure wave reflection over the aortic bifurcation without causing significant alterations in PWV.
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Affiliation(s)
- Efstratios Georgakarakos
- Department of Vascular Surgery, University Hospital of Alexandroupolis, "Democritus" University of Thrace , Alexandroupolis , Greece
| | - Christos Argyriou
- Department of Vascular Surgery, University Hospital of Alexandroupolis, "Democritus" University of Thrace , Alexandroupolis , Greece
| | - George S Georgiadis
- Department of Vascular Surgery, University Hospital of Alexandroupolis, "Democritus" University of Thrace , Alexandroupolis , Greece
| | - Miltos K Lazarides
- Department of Vascular Surgery, University Hospital of Alexandroupolis, "Democritus" University of Thrace , Alexandroupolis , Greece
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Georgakarakos E, Argyriou C, Ioannou CV, Kontopodis N, Lazarides MK. The Effect of Ovation Stent-Graft System on Aortic Pulse Wave Velocity: Preliminary Report on 3 Cases. Ann Vasc Surg 2015; 29:1658.e5-9. [DOI: 10.1016/j.avsg.2015.06.076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 06/21/2015] [Accepted: 06/21/2015] [Indexed: 10/23/2022]
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Beckmann M, Jacomella V, Kohler M, Lachat M, Salem A, Amann-Vesti B, Husmann M. Risk Stratification of Patients with Peripheral Arterial Disease and Abdominal Aortic Aneurysm Using Aortic Augmentation Index. PLoS One 2015; 10:e0139887. [PMID: 26452151 PMCID: PMC4599890 DOI: 10.1371/journal.pone.0139887] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 09/19/2015] [Indexed: 01/11/2023] Open
Abstract
Background Central augmentation index (cAIx) is an indicator for vascular stiffness. Obstructive and aneurysmatic vascular disease can affect pulse wave propagation and reflection, causing changes in central aortic pressures. Aim To assess and compare cAIx in patients with peripheral arterial disease (PAD) and / or abdominal aortic aneurysm (AAA). Methods cAIx was assessed by radial applanation tonometry (Sphygmocor) in a total of 184 patients at a tertiary referral centre. Patients were grouped as having PAD only, AAA only, or both AAA and PAD. Differences in cAIx measurements between the three patient groups were tested by non-parametric tests and stepwise multivariate linear regression analysis to investigate associations with obstructive or aneurysmatic patterns of vascular disease. Results In the study sample of 184 patients, 130 had PAD only, 20 had AAA only, and 34 patients had both AAA and PAD. Mean cAIx (%) was 30.5 ± 8.2 across all patients. It was significantly higher in females (35.2 ± 6.1, n = 55) than males (28.4 ± 8.2, n = 129), and significantly higher in patients over 80 years of age (34.4 ± 6.9, n = 22) than in those under 80 years (30.0 ± 8.2, n = 162). Intergroup comparison revealed a significant difference in cAIx between the three patient groups (AAA: 27.3 ± 9.5; PAD: 31.4 ± 7.8; AAA & PAD: 28.8 ± 8.5). cAIx was significantly lower in patients with AAA, higher in patients with both AAA and PAD, and highest in patients with PAD only (beta = 0.21, p = 0.006). Conclusion Non-invasive assessment of arterial stiffness in high-risk patients indicates that cAIx differs according to the pattern of vascular disease. Measurements revealed significantly higher cAIx values for patients with obstructive peripheral arterial disease than for patients with aneurysmatic disease.
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Affiliation(s)
- Marianne Beckmann
- Clinic for Angiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Angiology Division, Department of Internal Medicine, Kantonsspital St. Gallen, St Gallen, Switzerland
- * E-mail: (MB); (MH)
| | - Vincenzo Jacomella
- Clinic for Angiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Malcom Kohler
- Clinic for Pneumology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Mario Lachat
- Clinic for Cardiovascular Surgery, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Amr Salem
- Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Beatrice Amann-Vesti
- Clinic for Angiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Marc Husmann
- Clinic for Angiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- * E-mail: (MB); (MH)
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Studying the Flow Dynamics in an Aortic Endograft with Crossed-limbs. Int J Artif Organs 2014; 37:81-7. [DOI: 10.5301/ijao.5000292] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2013] [Indexed: 11/20/2022]
Abstract
Purpose To evaluate the flow phenomena within an aortic endograft with crossed-limbs, comparing to an endograft with the ordinary limb bifurcation. Methods An endograft model with crossed-limbs was computationally reconstructed based on Computed Tomography patient-specific data, using commercially available software. Accordingly, its analogue model was reconstructed in the ordinary fashion (ordinary bifurcation). Computational fluid dynamics analysis was performed to determine and compare the flow fields, velocity profiles, pressure and shear stress distribution throughout the different parts of both endograft configurations, in different phases of the cardiac cycle. Results The flow patterns between the “Ballerina” and the classic endograft were similar, with flow disturbance near the inlet zone at late diastole and smooth flow patterns during the systolic phase. Both configurations presented similar pressure distribution patterns throughout the cardiac cycle. The highest and lowest pressures were demonstrated in the inlet-main body area and the iliac limbs, respectively. Marked differences were observed in the velocity profiles of the proximal limb segments between the two configurations, mostly in the peak- and end-systolic phase. The regions of lower velocities correlated well to low shear values. Differences in the shear stress distribution were noted between the two configurations in the systolic and, predominantly, in the diastolic phase. Conclusions There are differences in the velocity profiles and shear distribution between the limbs of the two endograft configurations. The pathophysiologic implication of our findings and their possible association with clinical events, such as thrombus apposition, deserves further investigation.
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