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Abatzis-Papadopoulos M, Tigkiropoulos K, Nikas S, Sidiropoulou K, Alexou C, Stavridis K, Karamanos D, Kotsis V, Lazaridis I, Saratzis N. Study Protocol of a Prospective, Monocentric, Single-Arm Study Investigating the Correlation of Endograft Properties with Aortic Stiffness in Abdominal Aortic Aneurysm Patients Subjected to Endovascular Aortic Repair. J Clin Med 2024; 13:2205. [PMID: 38673477 PMCID: PMC11050864 DOI: 10.3390/jcm13082205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/05/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
The number of endovascular aortic repairs (EVARs) has surpassed the number of open surgical repairs of abdominal aortic aneurysms (AAAs) worldwide. The available commercial endoprostheses are composed of materials that are stiffer than the native aortic wall. As a consequence, the implantation of stent-graft endoprostheses during EVAR increases aortic rigidity and thus aortic stiffness, resulting in a decrease in abdominal aorta compliance. EVAR has been found to have a possibly harmful effect not only on heart functions but also on other vascular beds, including kidney function, due to the decrease in aortic compliance that it causes. Aortic stiffness is measured by various hemodynamic indices like the pulse wave velocity (PWV), the central aortic pressure (CAP), and the augmentation index (AIx). In the literature, there are increasing numbers of studies investigating the properties of endografts, which are strongly related to increases in aortic stiffness. However, there is a lack of data on whether there is a correlation between the length of various endografts implanted during EVAR and the increase in the PWV, CAP, and AIx postoperatively compared to the preoperative values. The aim of this prospective, observational, monocentric, single-arm study is to investigate the correlation between endograft length and the postoperative increase in the PWV, CAP, and AIx in patients subjected to EVAR. Additionally, this study intends to identify other endograft properties related to increases in the PWV, CAP, and AIx. Other endpoints to be studied are the existence of immediate postoperative myocardial and kidney injury after EVAR. The prediction of cardiovascular events caused by endograft-related increased aortic stiffness could contribute to the improvement of various endograft properties so that the impact of endografts on the native aortic wall can be minimized.
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Affiliation(s)
- Manolis Abatzis-Papadopoulos
- Vascular Unit, 1st University Surgical Department, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece; (K.T.); (K.S.); (K.S.); (D.K.); (I.L.); (N.S.)
| | - Konstantinos Tigkiropoulos
- Vascular Unit, 1st University Surgical Department, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece; (K.T.); (K.S.); (K.S.); (D.K.); (I.L.); (N.S.)
| | - Spyridon Nikas
- Radiology Department, Papageorgiou General Hospital, 56403 Thessaloniki, Greece;
| | - Katerina Sidiropoulou
- Vascular Unit, 1st University Surgical Department, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece; (K.T.); (K.S.); (K.S.); (D.K.); (I.L.); (N.S.)
| | - Christina Alexou
- Cardiothoracic Surgery Department, Papanikolaou General Hospital, 57010 Thessaloniki, Greece;
| | - Kyriakos Stavridis
- Vascular Unit, 1st University Surgical Department, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece; (K.T.); (K.S.); (K.S.); (D.K.); (I.L.); (N.S.)
| | - Dimitrios Karamanos
- Vascular Unit, 1st University Surgical Department, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece; (K.T.); (K.S.); (K.S.); (D.K.); (I.L.); (N.S.)
| | - Vasilios Kotsis
- 3rd University Department of Internal Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece;
| | - Ioannis Lazaridis
- Vascular Unit, 1st University Surgical Department, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece; (K.T.); (K.S.); (K.S.); (D.K.); (I.L.); (N.S.)
| | - Nikolaos Saratzis
- Vascular Unit, 1st University Surgical Department, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece; (K.T.); (K.S.); (K.S.); (D.K.); (I.L.); (N.S.)
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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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Spinella G, Boschetti GA, Bauckneht M, Raffa S, Marini C, Finotello A, Pane B, Pratesi G, Palombo D, Sambuceti G. Endovascular aortic repair impact on myocardial contractility: A prospective study. Eur J Clin Invest 2023; 53:e14011. [PMID: 37099603 DOI: 10.1111/eci.14011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 04/07/2023] [Accepted: 04/24/2023] [Indexed: 04/27/2023]
Abstract
BACKGROUND This study aimed to estimate if the altered sphygmic wave transmission may affect the left ventricular (LV) contractile function in patients undergoing endovascular aortic repair (EVAR). METHODS A prospective single-centre study was carried out on consecutive patients undergoing EVAR for abdominal aortic aneurysm. A preoperative and 6-month single photon emission computed tomography (SPECT) with arterial stiffness measurement were performed to evaluate variations in pressure wave curve and myocardial perfusion parameters. RESULTS From 2018 to 2020 a total of 16 patients were included in the study. Among the parameters evaluated, we found a measurable reduction of the reflected wave transit time from pre- to postoperative period, for both stress (115.13 ± 7.2 ms-111.1 ± 7.0 ms, p = .08) and rest SPECT acquisitions (115.3 ± 6.2 ms-112.2 ± 5.6 ms, p = .1). Unidirectional increase of both LV end-systolic volume (34 ± 9 mL-39 ± 8 mL, p = .02) and end-diastolic volume (85 ± 34 mL-89 ± 29 mL, p = .6) was also observed. Lastly, the ratio between the end-systolic pressure and the end-systolic volume (maximal systolic myocardial stiffness) decreased from 3.6 ± 1.5 mmHg/mL to 2.66 ± .74 mmHg/mL (p = .03). CONCLUSIONS Our data showed that EVAR induced an altered transmission of the sphygmic wave associated with an early LV contractile impairment.
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Affiliation(s)
- Giovanni Spinella
- Vascular and Endovascular Surgery Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Gian Antonio Boschetti
- Vascular and Endovascular Surgery Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Matteo Bauckneht
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Stefano Raffa
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Cecilia Marini
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- CNR Institute of Molecular Bioimaging and Physiology (IBFM), Segrate, Italy
| | - Alice Finotello
- Vascular and Endovascular Surgery Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Bianca Pane
- Vascular and Endovascular Surgery Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Giovanni Pratesi
- Vascular and Endovascular Surgery Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Domenico Palombo
- Vascular and Endovascular Surgery Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Gianmario Sambuceti
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
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Sultan S, Acharya Y, Soliman O, Parodi JC, Hynes N. TEVAR and EVAR, the unknown knowns of the cardiovascular hemodynamics; and the immediate and long-term consequences of fabric material on major adverse clinical outcome. Front Surg 2022; 9:940304. [PMID: 36111231 PMCID: PMC9468223 DOI: 10.3389/fsurg.2022.940304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/11/2022] [Indexed: 11/29/2022] Open
Abstract
This review discusses the impact of endovascular aneurysm repair on cardiovascular (CV) hemodynamics and the role of stent-graft material, i.e., polytetrafluoroethylene (PTFE) vs. polyester in post-procedural outcomes. Endovascular aneurysm repair has been widely employed in the last decades for thoracic and abdominal aneurysm repair. However, aortic endografts are stiff and alter the native flow hemodynamics. This failure to simulate the native aorta could lead to added strain on the heart, manifesting as increased left ventricular strain, higher pulse pressure, and congestive heart failure later. This could result in adverse CV outcomes. Also, evidence is mounting to support the implication of stent-graft materials, i.e., PTFE vs. polyester, in adverse post-procedural outcomes. However, there is an absence of level one evidence. Therefore, the only way forward is to plan and perform a randomised controlled trial to demonstrate the alterations in the CV hemodynamics in the short and long run and compare the available stent-graft materials regarding procedural and clinical outcomes. We believe the best solution, for now, would be to reduce the stented length of the aorta. At the same time, in the longer term, encourage continuous improvement in stent-graft materials and design.
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Affiliation(s)
- Sherif Sultan
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, University Hospital Galway, National University of Ireland, Galway, Ireland
- Galway Clinic, Doughiska, Royal College of Surgeons in Ireland and the National University of Ireland, Galway Affiliated Hospital, Galway, Ireland
- CÚRAM-CORRIB-Vascular Group, National University of Ireland, Galway, Ireland
- Correspondence: Sherif Sultan ,
| | - Yogesh Acharya
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, University Hospital Galway, National University of Ireland, Galway, Ireland
- Galway Clinic, Doughiska, Royal College of Surgeons in Ireland and the National University of Ireland, Galway Affiliated Hospital, Galway, Ireland
| | - Osama Soliman
- CÚRAM-CORRIB-Vascular Group, National University of Ireland, Galway, Ireland
| | - Juan Carlos Parodi
- Department of Vascular Surgery and Biomedical Engineering Department, University of Buenos Aires, Buenos Aires, Argentina
| | - Niamh Hynes
- CÚRAM-CORRIB-Vascular Group, National University of Ireland, Galway, Ireland
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Sultan S, Acharya Y, Hazima M, Salahat H, Parodi JC, Hynes N. Combined thoracic endovascular aortic repair and endovascular aneurysm repair and the long-term consequences of altered cardiovascular haemodynamics on morbidity and mortality: case series and literature review. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytab339. [PMID: 34622129 PMCID: PMC8493011 DOI: 10.1093/ehjcr/ytab339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/18/2021] [Accepted: 08/13/2021] [Indexed: 11/14/2022]
Abstract
Background Thoracic and abdominal aortic stent grafts are firmer and more rigid than the native aorta. Aortic implanted devices have been implicated in the development of acute systolic hypertension, elevated pulse pressure, and reduced coronary perfusion. Case summary We report four cases of staged thoracic endovascular aortic repair (TEVAR) and then endovascular aneurysm repair (EVAR). All patients had TEVAR first for thoracic aortic aneurysm and later on developed infra-renal abdominal aortic aneurysm (AAA) that required EVAR. There were three males and one female with a median age of 74.5 years (range 67.5-78.5). None of the patients developed aortic-related major clinical adverse effects or required any aortic intervention during their follow-up. However, within 2 years, all patients developed symptomatic left ventricular hypertrophy with diastolic dysfunction. All patients had bilateral lower limb oedema, with on and off chest pain and shortness of breath (SOB), necessitating coronary angiograms, which showed no evidence of coronary artery disease. Three patients died from cardiovascular-related morbidities, and the fourth patient is still complaining of SOB despite a normal coronary angiogram. Discussion Aortic-endograft compliance mismatch is an invisible enemy, with troubling consequences for the aorta proximal and distal to the endograft. Aortic stiffness due to vascular endograft could lead to cardiovascular adverse events, even in the absence of direct aortic-related complications. After combined TEVAR and EVAR, the compliance mismatch and elasticity loss are even more pronounced than with TEVAR alone, which necessitates patient monitoring for the development of cardiovascular complications.
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Affiliation(s)
- Sherif Sultan
- Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, National University of Ireland, Newcastle Road, Galway H91 YR71, Ireland.,Department of Vascular and Endovascular Surgery, Galway Clinic, Doughiska, Royal College of Surgeons in Ireland and the National University of Ireland, Galway Affiliated Hospital, Ireland
| | - Yogesh Acharya
- Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, National University of Ireland, Newcastle Road, Galway H91 YR71, Ireland.,Department of Vascular and Endovascular Surgery, Galway Clinic, Doughiska, Royal College of Surgeons in Ireland and the National University of Ireland, Galway Affiliated Hospital, Ireland
| | - Mohiey Hazima
- Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, National University of Ireland, Newcastle Road, Galway H91 YR71, Ireland
| | - Hiba Salahat
- Department of Vascular and Endovascular Surgery, Galway Clinic, Doughiska, Royal College of Surgeons in Ireland and the National University of Ireland, Galway Affiliated Hospital, Ireland
| | - Juan Carlos Parodi
- Department of Vascular Surgery and Biomedical Engineering Department, Alma mater, University of Buenos Aires, Wake Forest University, Washington University in St. Louis, and Trinidad Hospital, Buenos Aires, Argentina
| | - Niamh Hynes
- Department of Vascular and Endovascular Surgery, Galway Clinic, Doughiska, Royal College of Surgeons in Ireland and the National University of Ireland, Galway Affiliated Hospital, Ireland
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