Impact of stent materials and hemodynamic changes after endovascular aneurysm repair for abdominal aortic aneurysm

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Abdominal aortic aneurysm (n=265). Intervention: Endovascular aneurysm repair (EVAR). Primary outcome: 2-year all-cause mortality (per 1-SD increase in change of carotid-femoral pulse wave velocity) (HR 4.011, 95% CI 1.154-13.950, p=0.029).

Chih-Hsueh Tseng; Wei-Min Huang; Liang‐Yin Lin; Wen-Chung Yu; Chun-Che Shih; Chern-En Chiang; Chen-Huan Chen; S H Sung

doi:10.1038/s41440-026-02595-8

March 30, 2026Hypertension ResearchOpen Access

Impact of stent materials and hemodynamic changes after endovascular aneurysm repair for abdominal aortic aneurysm

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Key result

An increase in carotid-femoral pulse wave velocity following endovascular aneurysm repair was an independent predictor of 2-year all-cause mortality (HR 4.011).

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Why the study?

EVAR is associated with increased arterial stiffness, but the impact of different stent-graft materials on arterial stiffness and clinical outcomes in AAA patients remained unclear.

Does the choice of stent material and fabric affect arterial stiffness and mortality in patients with abdominal aortic aneurysm undergoing EVAR?

Key Points

To investigate the impact of different stent-graft materials on arterial stiffness measurements and clinical outcomes in patients undergoing endovascular aortic repair for abdominal aortic aneurysm.
Included 265 patients (mean age 75.1 ± 11.7 years, 88.3% men) undergoing endovascular aortic repair (EVAR) for abdominal aortic aneurysm, receiving either nitinol (n = 133) or stainless-steel (n = 132) stents.
Measured pulsatile hemodynamic parameters—carotid-femoral pulse wave velocity (cf-PWV), carotid augmentation index (cAI), and backward pressure amplitude (Pb)—at baseline and 1 month post-EVAR.
Assessed all-cause mortality over a 2-year post-discharge follow-up period through linkage with the National Death Registry.
Carotid-femoral pulse wave velocity increased significantly from 12.34 ± 3.11 m/s at baseline to 13.07 ± 3.49 m/s at 1 month post-EVAR (p = 0.005), with stainless-steel stents demonstrating a significantly smaller increase than nitinol stents after adjusting for mean blood pressure (interaction p = 0.018).
During the 2-year follow-up, 25 patients (9.4%) died, with significantly higher mortality observed in the nitinol group compared to the stainless-steel group (log-rank p = 0.013).
Post-EVAR change in cf-PWV independently predicted 2-year all-cause mortality after adjusting for age, gender, aneurysm diameter, and baseline cf-PWV (HR per 1-SD 4.011, 95% CI 1.154–13.950, p = 0.029).

Study Design

Type

Cohort (n=265)

Multicenter

No

Structured PICO

Does the choice of stent material and fabric affect arterial stiffness and mortality in patients with abdominal aortic aneurysm undergoing EVAR?

P

Population

Patients with abdominal aortic aneurysm (AAA) undergoing endovascular aortic repair (EVAR), excluding acute aortic syndrome, active malignancy, or non-sinus rhythm; mean age 75.1 years, 88.3% male.

I

Intervention

Nitinol stents and/or Dacron stent-graft fabrics

C

Comparator

Stainless-steel stents and/or PTFE stent-graft fabrics

O

Outcome

Changes in pulsatile hemodynamics (cf-PWV, cAI, Pb) at 1 month and all-cause mortality up to 2 years post-dischargehard clinical

Main Result

Effect estimate: HR 4.011 (95% CI 1.154-13.950)

p-value: p=0.029

In patients undergoing EVAR for abdominal aortic aneurysm, the use of nitinol stents and Dacron fabrics is associated with increased arterial stiffness and higher 2-year mortality compared to stainless-steel stents and PTFE fabrics.

Limitations

Sample size may limit the generalizability of the findings to the broader EVAR population
Pulsatile hemodynamics were assessed only at baseline and 1 month
Detailed anatomic and clinical determinants of device selection were not systematically collected
Sample size or power calculation was not performed as this study was an observational cohort

Implication

Choice of EVAR stent material may alter long-term mortality risk; hypothesis-generating data challenges material equivalence and warrants RCTs.

Abstract

Endovascular aortic repair (EVAR) treatment was associated with increase in arterial stiffness following the procedure abdominal aortic aneurysm (AAA). This study aims to investigate the impact of different stent-graft materials on arterial stiffness measurements and the outcomes of AAA patients undergoing EVAR. Patients with AAA undergoing EVAR were eligible for this study. Pulsatile hemodynamic parameters, including carotid-femoral pulse wave velocity (cf-PWV), carotid augmentation index (cAI), and backward pressure amplitude (Pb), were measured before and 1 month after the EVAR procedure. All-cause mortality up to 2 years post-discharge was determined by linking the study population to the National Death Registry. Among a total of 265 study participants (age 75.1 ± 11.7 years, 88.3% men), the length and diameter of the aneurysm were 7.95 ± 2.61 cm and 5.88 ± 2.08 cm, respectively. One month after EVAR, cf-PWV significantly increased, and only cf-PWV showed a significant between-group difference among stainless-steel and nitinol stent group after adjusting for MBP. At the 2-year follow-up, mortality was significantly higher in the nitinol vs. stainless-steel group and the Dacron vs. PTFE group. Furthermore, changing of cf-PWV following EVAR was an independent predictor of mortality [hazard ratio (HR) per 1-SD and 95% confidence interval (CI): 4.011 (1.154–13.950), p = 0.029] after accounting for confounding factors. The stent materials and fabric may influence the change of pulsatile hemodynamics after EVAR. Higher mortality rates were observed in those treated with Dacron fabric and nitinol stents, and Δcf-PWV was an independent predictor of mortality.

Discussion

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Cite This Study

Tseng et al. (2026) conducted a cohort in Abdominal aortic aneurysm (n=265). Endovascular aneurysm repair (EVAR) was evaluated on 2-year all-cause mortality (per 1-SD increase in change of carotid-femoral pulse wave velocity) (HR 4.011, 95% CI 1.154-13.950, p=0.029). An increase in carotid-femoral pulse wave velocity following endovascular aneurysm repair was an independent predictor of 2-year all-cause mortality (HR 4.011).

synapsesocial.com/papers/69ccb79916edfba7beb89a62 https://doi.org/10.1038/s41440-026-02595-8

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Impact of stent materials and hemodynamic changes after endovascular aneurysm repair for abdominal aortic aneurysm

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Impact of stent materials and hemodynamic changes after endovascular aneurysm repair for abdominal aortic aneurysm

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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