Key result
Diabetes linked to a ~23% lower likelihood of aneurysm sac shrinkage one year post-EVAR.
Why the study?
The influence of diabetes mellitus and metformin treatment on aneurysm sac remodeling following endovascular aneurysm repair was unknown.
Does diabetes mellitus and metformin treatment impact aneurysm sac remodeling and overall survival in patients undergoing elective EVAR for infrarenal AAA?
Cohort (n=529)
No
Does diabetes mellitus and metformin treatment impact aneurysm sac remodeling and overall survival in patients undergoing elective EVAR for infrarenal AAA?
Absolute Event Rate: 40% vs 52%
p-value: p=0.038
Diabetes mellitus, regardless of metformin use, is associated with reduced aneurysm sac shrinkage and lower overall survival following elective EVAR for infrarenal AAA.
Diabetes-associated reduction in post-EVAR sac shrinkage warrants closer surveillance; leaves open metformin effects and causal impact on survival.
Objective: To study the influence of diabetes mellitus (DM) and metformin treatment on aneurysm sac remodeling after endovascular aneurysm repair (EVAR). Methods: A retrospective single-center cohort analysis was conducted on consecutive patients who underwent elective EVAR for an infrarenal abdominal aortic aneurysm (AAA) between January 2011 and December 2021. Differences between study groups were analyzed and Kaplan–Meier analysis were employed to describe overall and reintervention-free survival. Cox regression analysis was performed to identify predictors of sac shrinkage. Results: A total of 529 patients were included: 74 (14.0%) had DM and metformin treatment, 26 (4.9%) had DM without metformin treatment, and 429 (81.1%) did not have DM. At one-year follow-up, diabetic patients showed significantly less sac shrinkage compared to non-diabetic patients (40.0% vs. 52.0%; p = 0.038), with a trend toward more stable sac behavior in diabetic patients (52% vs. 42%; p = 0.055). At last follow-up, sac shrinkage was significantly less in diabetic patients on metformin treatment compared to non-diabetics (48.6% vs. 59.9%; p = 0.047). No differences in sac shrinkage were observed between diabetics with and without metformin treatment. The presence of endoleak was significantly higher in groups showing stable sac behavior and growth. Through nine-year follow-up, overall survival was significantly less in diabetic patients compared to non-diabetic ones (23.5% vs. 37.5%; p < 0.001). Conclusions: This study showed a negative impact of diabetes mellitus and metformin treatment on sac shrinkage following EVAR. The presence of any type of endoleak was associated with reduced sac shrinkage at both time points. Overall survival was significantly lower in diabetic patients compared to non-diabetic patients.
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Merrienboer et al. (2025) conducted a cohort in Infrarenal abdominal aortic aneurysm (AAA) (n=529). Diabetes mellitus vs. Non-diabetic patients was evaluated on Aneurysm sac shrinkage at one-year follow-up (p=0.038). Diabetic patients experienced significantly less aneurysm sac shrinkage at one-year follow-up after endovascular aneurysm repair compared to non-diabetic patients (40.0% vs. 52.0%).
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