Key result
Following EVAR, patients with an Excluder endograft demonstrated 94% and 60% higher elastic modulus and stiffness at the aneurysm neck compared to those with a Talent endograft (p<0.05).
Why the study?
Does endovascular aneurysm repair (EVAR) and specific endograft design alter aortic stiffness and elastic modulus in patients with abdominal aortic aneurysm?
Observational (n=11)
Does endovascular aneurysm repair (EVAR) and specific endograft design alter aortic stiffness and elastic modulus in patients with abdominal aortic aneurysm?
p-value: p=<0.05
Dynamic MRA demonstrates that EVAR increases aortic stiffness at the aneurysm sac, and endograft design significantly influences stiffness at the aneurysm neck.
May enable noninvasive post-EVAR stiffness monitoring; leaves open endograft or endoleak effects in larger cohorts.
PURPOSE: To utilize dynamic magnetic resonance angiography (MRA) to characterize aortic stiffness (beta) and elastic modulus (Ep) as indexes of wall compliance during the cardiac cycle and determine any influence of different endograft designs or the presence of endoleaks on these indexes. METHODS: Eleven consecutive patients (11 men; median age 74 years, range 63-78) with abdominal aortic aneurysm (AAA) selected for endovascular repair were scanned pre- and postoperatively. Aortic area and diameter changes during the cardiac cycle were determined using dynamic MRA at 4 levels: 3 cm above the renal arteries, between the renal arteries, 1 cm below the renal arteries, and at the level of maximum aneurysm sac diameter. Ep and beta were calculated. Data are presented as median (range); p<0.05 was considered significant. RESULTS: Preoperatively, Ep and beta were significantly higher at the level of the aneurysm sac compared to all other levels (p<0.05). Following EVAR, stiffness increased at this level (p<0.05). After implantation, patients with an Excluder endograft demonstrated Ep and beta measurements at the aneurysm neck that were 94% and 60% higher, respectively, compared to those with a Talent (p<0.05) endograft. The presence of an endoleak had no effect on Ep or beta. CONCLUSION: This study introduces the feasibility of dynamic MRA imaging-based calculations of aortic elastic modulus and stiffness. AAA patients demonstrate increased Ep and beta at the level of the aneurysm sac. EVAR results in increased aneurysm sac Ep and beta. Stent-graft design seems to alter Ep and beta within the aneurysm neck, which may have consequences for endograft durability. The presence of an endoleak does not seem to have an effect on Ep or beta.
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Herwaarden et al. (2006) conducted an observational in Abdominal aortic aneurysm (AAA) (n=11). EVAR (Excluder vs Talent endografts) vs. Preoperative state / Talent endograft was evaluated on Aortic stiffness (beta) and elastic modulus (Ep) (p=<0.05). Following EVAR, patients with an Excluder endograft demonstrated 94% and 60% higher elastic modulus and stiffness at the aneurysm neck compared to those with a Talent endograft (p<0.05).
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