One-Year Changes in Arterial Stiffness and Central Aortic Pressure in Hypertensive Patients With Aortic Aneurysm After Endovascular Aneurysm Repair

Objective: To assess the dynamics of arterial stiffness and central blood pressure (CBP) and investigate the factors affecting them in thoracic and abdominal aortic aneurysms patients with hypertension one year after [thoracic] endovascular aneurysm repair ([T]EVAR). Design and method: Patients older 18 y.o. without clinically significant arrhythmias were included. Before [T]EVAR and a year later, the following examination was performed: measurement of peripheral blood pressure and CBP, heart rate (HR), augmentation index (AIx), central pulse height at the point of maximum rise of direct pulse wave (PT1h), timing of reflected pulse wave (Tr) and carotid-femoral pulse wave velocity (cfPWV) by SphygmoCor (AtCor Medical, Australia). Results: Fifty patients were included (mean age 68±9 y.o., 41 males, 16 thoracic aortic aneurysms patients, 34 abdominal aortic aneurysms patients), and 23 were examined again onsite. At one year after [T]EVAR, there was an increase in cfPWV (+2.6 m/s, p<0.001), PT1h (+5 mm Hg, p=0.026), peripheral pulse pressure (+7 mm Hg, p=0.039), HR (+5 bpm, p=0.025). CBP and AIx did not change. The graft length directly affected (β=0.42), and HR exerted inverse (β=-0.52) association with the lengthening of Tr. Six cardiovascular complications were registered during follow-up. Conclusions: Implantation of the graft is associated with increased cfPWV, irrespective of the aneurysm location. The rise of PT1h one year after [T]EVAR may reflect a decrease in aortic compliance and a deterioration in the damping function of the aorta. The absence of CBP and AIx dynamics is probably explained by the features of the reflected wave postoperatively. Decreased HR and implantation of more extended grafts are predictors of increased Tr.