AORTIC STIFFNESS MODIFICATIONS AFTER ENDOVASCULAR AORTIC REPAIR

Background: Endovascular aortic repair (EVAR and TEVAR) has transformed the management of aortic aneurysms and dissections through its minimally invasive approach and favorable short-term outcomes. However, concerns regarding the long-term cardiovascular implications of endograft implantation have emerged, particularly related to aortic stiffness, a known predictor of cardiovascular morbidity and mortality. Objective: This study aimed to evaluate the modifications in aortic stiffness in patients undergoing endovascular aortic repair by measuring pulse wave velocity (PWV) using non-invasive applanation tonometry before and after intervention. Moreover, other parameters measuring cardiac performance have been included as secondary outcomes. Methods: A prospective study was conducted at Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico in Milan, Italy, from October 1, 2023, to April 30, 2025. Patients aged 18 and older, indicated for elective TEVAR or EVAR, were enrolled. Exclusion criteria included emergency procedures, significant comorbidities hindering measurement with tonometer or wave analysis (e.g. atrial fibrillation, compromised skin integrity). Data collection encompassed demographic information, comorbidities, medication use, vital signs, and laboratory values. PWV was calculated preoperatively and postoperatively, and waveform analysis was performed to assess arterial stiffness and hemodynamic parameters. Results: A total of 76 patients underwent endovascular aortic procedures, with 53 included in the analysis (38 EVAR/FEVAR and 15 TEVAR). Preoperative mean cf-PWV was 9.4 ± 2.8 m/s and increased significantly to 11.1 ± 3.8 m/s postoperatively (p = 0.019), representing an approximate 18% increase. Additionally, the Subendocardial Viability Ratio (SEVR) decreased significantly from 132.9 ± 32.1% preoperatively to 110.7 ± 29.4% postoperatively (p < 0.001), indicating potential implications for myocardial perfusion. Waveform analysis revealed significant alterations in several parameters, including reductions in Peak Time and changes in wave reflection dynamics, which suggest increased arterial stiffness. Conclusions: The findings indicate that endovascular aortic repair is associated with a significant increase in arterial stiffness and alterations in arterial hemodynamics. These changes highlight the need for ongoing monitoring of arterial stiffness and cardiovascular health in patients following EVAR and TEVAR. Future research should focus on larger cohorts to further elucidate the long-term implications of endograft materials and surgical techniques on cardiovascular outcomes. Understanding these parameters is crucial for optimizing patient management strategies and mitigating risks associated with increased aortic stiffness.