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Rašiová M, Koščo M, Moščovič M, Pavlíková V, Habalová V, Židzik J, Tormová Z, Hudák M, Bavoľárová M, Perečinský S, Dekanová L, Tkáč I. Factors associated with all-cause mortality following endovascular abdominal aortic aneurysm repair. VASA 2023; 52:325-331. [PMID: 37350324 DOI: 10.1024/0301-1526/a001081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Background: Knowledge of factors that influence all-cause mortality after endovascular abdominal aortic aneurysm repair (EVAR) could improve therapeutic strategies post-EVAR and thus patient prognosis. Our study aimed to evaluate the association between sociodemographic information, comorbidities, laboratory parameters, treatment, selected anatomical and genetic factors and all-cause mortality post-EVAR. Patients and methods: We reviewed all patients who had undergone elective EVAR for non-ruptured abdominal aortic aneurysm (AAA) between January 2010 and December 2019. AAA size (maximum diameter and volume) was measured using CT-angiography. Sac expansion was defined as at least 5 mm increase, sac regression as at least 5 mm decrease in the sac diameter determined at 36±3 months post-EVAR in relation to pre-EVAR AAA diameter. Adjustments were performed for age, hypertension, diabetes mellitus, dyslipidaemia, sex, smoking, number of lumbar arteries, patency of inferior mesenteric artery and number of reinterventions post-EVAR. Results: One hundred and sixty-two patients (150 men, 12 women) with a mean age of 72.6±7.3 years were included in the analysis. Pre-EVAR AAA diameter (HR 1.07; 95% CI 1.03 - 1.12; p=0.001), pre-EVAR AAA volume (HR 1.01; 95% CI 1.002 - 1.011; p=0.008), post-EVAR sac diameter (HR 1.06; 95% CI 1.03 - 1.10; p=0.000), post-EVAR sac volume (HR 1.01; 95% CI 1.002 - 1.011; p=0.006) and anticoagulation therapy (HR 2.46; 95% CI 1.18 - 5.14; p=0.019) were associated with higher mortality in multivariate analysis. Sac regression (HR 0.42; 95% CI 0.22 - 0.82; p=0.011), and treatment with angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) (HR 0.71; 95% CI 0.36 - 0.97; p=0.047) were associated with lower mortality. Conclusions: Greater pre- and post-EVAR diameter and volume, failure of sac regression and anticoagulation were associated with higher mortality post-EVAR. Reduced mortality was observed in patients treated with ACE inhibitors or ARBs, and in patients with AAA sac regression.
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Affiliation(s)
- Mária Rašiová
- Department of Angiology, Faculty of Medicine, East Slovak Institute of Cardiovascular Diseases, University of Pavol Jozef Šafárik, Košice, Slovakia
| | - Martin Koščo
- Department of Angiology, Faculty of Medicine, East Slovak Institute of Cardiovascular Diseases, University of Pavol Jozef Šafárik, Košice, Slovakia
| | - Matej Moščovič
- Department of Angiology, Faculty of Medicine, East Slovak Institute of Cardiovascular Diseases, University of Pavol Jozef Šafárik, Košice, Slovakia
| | - Veronika Pavlíková
- Department of Angiology, Faculty of Medicine, East Slovak Institute of Cardiovascular Diseases, University of Pavol Jozef Šafárik, Košice, Slovakia
| | - Viera Habalová
- Department of Medicine Biology, Faculty of Medicine, University of Pavol Jozef Šafárik, Košice, Slovakia
| | - Jozef Židzik
- Department of Medicine Biology, Faculty of Medicine, University of Pavol Jozef Šafárik, Košice, Slovakia
| | - Zuzana Tormová
- Department of Angiology, Faculty of Medicine, East Slovak Institute of Cardiovascular Diseases, University of Pavol Jozef Šafárik, Košice, Slovakia
| | - Marek Hudák
- Department of Angiology, Faculty of Medicine, East Slovak Institute of Cardiovascular Diseases, University of Pavol Jozef Šafárik, Košice, Slovakia
| | - Marta Bavoľárová
- Department of Cardiology, Štefan Kukura Hospital, Michalovce, Slovakia
| | - Slavomír Perečinský
- Department of Occupational Medicine and Clinical Toxicology, Faculty of Medicine, University of Pavol Jozef Šafárik, Košice, Slovakia
| | - Lucia Dekanová
- Department of Angiology, Faculty of Medicine, East Slovak Institute of Cardiovascular Diseases, University of Pavol Jozef Šafárik, Košice, Slovakia
| | - Ivan Tkáč
- Department of Internal Medicine 4, Faculty of Medicine, University of Pavol Jozef Šafárik, Košice, Slovakia
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Rašiová M, Koščo M, Moščovič M, Habalová V, Židzik J, Tormová Z, Bavoľárová M, Perečinský S, Hudák M, Kočan L, Tkáč I. Positive association between calcium channel blocker treatment and persistent type II endoleak. INT ANGIOL 2022; 41:277-284. [PMID: 35373941 DOI: 10.23736/s0392-9590.22.04847-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Type II endoleaks are the most common complication occuring after endovascular abdominal aortic aneurysm repair (EVAR). The aim of our study was to evaluate the impact of persistent type II endoleak on sac dynamics post-EVAR, and to study the association between non-anatomical factors including polymorphisms associated with abdominal aortic aneurysm (AAA) and persistent type II endoleak. METHODS The cohort comprises of 210 patients undergoing EVAR between January, 2010 and December, 2018. A persistent type II endoleak was defined as any type II endoleak lasting longer than six months and included also a type II endoleak diagnosed after six months or more post-EVAR during the 36-month follow-up period confirmed with CT-angiography. Anteroposterior AAA maximum diameter and AAA volume were measured pre-EVAR and 36 months post-EVAR using CT-angiographic pictures. Sac progression was defined as at least 5 mm increase, sac regression as at least 5 mm decrease in the sac diameter in relation to the preprocedural diameter. Sociodemographic information, comorbidities, treatment, laboratory parameters, selected anatomical and genetic factors were all analysed to determine their impact on persistent type II endoleak. The adjustments included age, hypertension, diabetes mellitus, dyslipidaemia, sex, smoking in multivariate analyses. When postprocedural diameter and volume were evaluated, adjustments included also preprocedural diameter/volume. RESULTS After exclusion, 178 pacients with mean age 72.4±7.60 years remained for analysis. Persistent type II endoleak was found in 27.5% of patients (n=49) and 2.94-times increased risk of sac progression in multivariate analysis (p=0.033). In multivariate analysis, AAA diameter in patients with persistent type II endoleak was 4.31 mm greater than in patients without (B=4.31; p=0.014); and its presence was also associated with 22.0 cm³ greater sac volume (B=22.0; p=0.034) compared to patients without persistent type II endoleak. Treatment with calcium channel blockers increased risk of persistent type II endoleak 2.11-times in multivariate analysis (OR 2.11; 95% CI 1.05-4.25; p=0.037). No association between persistent type II endoleak and selected polymorphisms associated with AAA and other observed factors was found. CONCLUSIONS Risk of persistent type II endoleak was more than doubled in patients taking calcium channel blockers. Patients with persistent type II endoleak had greater anteroposterior sac diameter and sac volume compared to patients without persistent type II endoleak.
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Affiliation(s)
- Mária Rašiová
- Department of Angiology, East Slovak Institute of Cardiovascular Diseases, Faculty of Medicine, Šafárik University, Košice, Slovakia -
| | - Martin Koščo
- Department of Angiology, East Slovak Institute of Cardiovascular Diseases, Faculty of Medicine, Šafárik University, Košice, Slovakia
| | - Matej Moščovič
- Department of Angiology, East Slovak Institute of Cardiovascular Diseases, Faculty of Medicine, Šafárik University, Košice, Slovakia
| | - Viera Habalová
- Department of Medicine Biology, Faculty of Medicine, Šafárik University, Košice, Slovakia
| | - Jozef Židzik
- Department of Medicine Biology, Faculty of Medicine, Šafárik University, Košice, Slovakia
| | - Zuzana Tormová
- Department of Angiology, East Slovak Institute of Cardiovascular Diseases, Faculty of Medicine, Šafárik University, Košice, Slovakia
| | - Marta Bavoľárová
- Department of Cardiology, Štefan Kukura Hospital, Michalovce, Slovakia
| | - Slavomír Perečinský
- Department of Occupational Medicine and Clinical Toxicology, Faculty of Medicine, Šafárik University, Košice, Slovakia
| | - Marek Hudák
- Department of Angiology, East Slovak Institute of Cardiovascular Diseases, Faculty of Medicine, Šafárik University, Košice, Slovakia
| | - Ladislav Kočan
- Department of Anaesthesiology and Intensive Medicine, East Slovak Institute of Cardiovascular Diseases, Faculty of Medicine, Šafárik University, Košice, Slovakia
| | - Ivan Tkáč
- Department of Internal Medicine 4, Faculty of Medicine, Šafárik University, Košice, Slovakia
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