Arterial Stiffness and Aortic Aneurysmal Disease – A Narrative Review

Abstract

It has been documented that large-artery stiffness is independently associated with increased cardiovascular risk and may potentially lead to heart and kidney failure and cerebrovascular disease. A systematic review of studies investigating changes in arterial stiffness in patients undergoing endovascular repair of aortic disease was conducted. In addition, a review of the available literature was performed, analyzing findings from studies using the cardio-ankle vascular index (CAVI) as a marker of arterial stiffness. Overall, 26 studies were included in the present analysis. Our research revealed a high heterogeneity of included studies regarding the techniques used to assess the aortic stiffness. Aortic stiffness was assessed by pulse wave velocity (PWV), elastic modulus (Ep), and augmentation index (AI). Currently a few studies exist investigating the role of CAVI in patients having an aortic aneurysm or undergoing endovascular aortic repair. The majority of studies showed that the treatment of an abdominal aortic aneurysm (AAA) either with open repair (OR) or endovascular aortic repair (EVAR) reduces aortic compliance significantly. Whether EVAR reconstruction might contribute a higher effect on arterial stiffness compared to OR needs further focused research. An increase of arterial stiffness was uniformly observed in studies investigating patients following thoracic endovascular aortic repair (TEVAR), and the effect was more pronounced in young patients. The effects of increased arterial stiffness after EVAR and TEVAR on the heart and the central hemodynamic, and an eventual effect on cardiac systolic function, need to be further investigated and evaluated in large studies and special groups of patients.

Study Protocol of a Prospective, Monocentric, Single-Arm Study Investigating the Correlation of Endograft Properties with Aortic Stiffness in Abdominal Aortic Aneurysm Patients Subjected to Endovascular Aortic Repair

“…This increase in PWV has been attributed to the increase in aortic rigidity that the implantation of aortic endoprostheses causes [6]. Similarly, Moulakakis et al, in their narrative review, support that the treatment of an AAA with EVAR reduces aortic compliance significantly, and an increase in arterial stiffness was uniformly observed in studies investigating patients following TEVAR, and the effect was more pronounced in young patients [24].Apart from a decrease in aortic compliance and an increase in aortic stiffness, EVAR has been related to reduced cardiac systolic function, heart diastolic dysfunction, and left ventricle hypertrophy [25,26]. Studies mention the possible harmful effect of EVAR not only on heart functions but also on other vascular beds, including kidney function [25][26][27].…”