Key result
Endovascular aneurysmal repair for fusiform abdominal aortic aneurysm resulted in a 1.7-fold increase in total energy loss (0.487 vs. 0.292 mW) compared to pre-EVAR measurements.
Why the study?
Although endovascular aneurysmal repair is a preferred treatment for abdominal aortic aneurysm, its impact on local hemodynamics in terms of energy loss has not been fully assessed.
Does endovascular aneurysmal repair (EVAR) affect local hemodynamics and energy loss in patients with fusiform abdominal aortic aneurysm?
Observational (n=13)
Does endovascular aneurysmal repair (EVAR) affect local hemodynamics and energy loss in patients with fusiform abdominal aortic aneurysm?
Effect estimate: 1.7-fold increase
Absolute Event Rate: 0.487% vs 0.292%
EVAR for fusiform abdominal aortic aneurysm significantly increases local energy loss, which correlates with post-procedural BNP levels, particularly in patients with deformed stent-grafts.
EVAR-linked energy loss rise may correlate with BNP elevation in deformed stent-grafts; leaves open whether design optimization improves hemodynamics.
BACKGROUND: Although endovascular aneurysmal repair (EVAR) is a preferred treatment for abdominal aortic aneurysm (AAA) owing to its low invasiveness, its impact on the local hemodynamics has not been fully assessed. PURPOSE: To elucidate how EVAR affects the local hemodynamics in terms of energy loss (EL). STUDY TYPE: Prospective single-arm study. FIELD STRENGTH/SEQUENCE: A 3.0 T/4D flow MRI using a phase-contrast three-dimensional cine-gradient-echo sequence. POPULATION: A total of 13 consecutive patients (median [interquartile range] age: 77.0 [73.0, 78.8] years, 11 male) scheduled for EVAR as an initial treatment for fusiform AAA. ASSESSMENT: 4D flow MRI covering the abdominal aorta and bilateral common iliac arteries and the corresponding stent-graft (SG) lumen was performed before and after EVAR. Plasma brain natriuretic peptide (BNP) was measured within 1 week before and 1 month after EVAR. The hemodynamic data, including mean velocity and the local EL, were compared pre-/post-EVAR. EL was correlated with AAA neck angle and with BNP. Patients were subdivided into deformed (N = 5) and undeformed SG subgroups (N = 8) and pre-/post-EVAR BNP compared in each. STATISTICS: Parametric or nonparametric methods. Spearman's rank correlation coefficients (r). The interobserver/intraobserver variabilities with Bland-Altman plots. A P value < 0.05 is considered significant. RESULTS: The mean velocity (cm/sec) at the AAA was five times greater after EVAR: 4.79 ± 0.32 vs. 0.91 ± 0.02. The total EL (mW) increased by 1.7 times after EVAR: 0.487 (0.420, 0.706) vs. 0.292 (0.192, 0.420). The total EL was proportional to the AAA neck angle pre-EVAR (r = 0.691) and post-EVAR (r = 0.718). BNP (pg/mL) was proportional to the total EL post-EVAR (r = 0.773). In the deformed SG group, EL (0.349 [0.261, 0.416]) increased 2.4-fold to 0.848 (0.597, 1.13), and the BNP 90.3 (53.6, 105) to 100 (67.2, 123) post-EVAR. CONCLUSION: The local EL showed a 1.7-fold increase after EVAR. The larger increase in the EL in the deformed SG group might be a potential concern for frail patients. EVIDENCE LEVEL: 1 TECHNICAL EFFICACY: Stage 2.
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Horiguchi et al. (2022) conducted an observational in Fusiform abdominal aortic aneurysm (n=13). Endovascular aneurysmal repair (EVAR) vs. Pre-EVAR baseline was evaluated on Total energy loss (EL) in mW (1.7-fold increase). Endovascular aneurysmal repair for fusiform abdominal aortic aneurysm resulted in a 1.7-fold increase in total energy loss (0.487 vs. 0.292 mW) compared to pre-EVAR measurements.
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