Effect of endoskeleton stent graft design on pulse wave velocity in patients undergoing endovascular repair of the aortic arch

Hori, Daijiro; Akiyoshi, Kei; Yasuda, Kôichi; Nishi, Satoshi; Nonaka, T; Yamamoto, Takahiro; Imamura, Yusuke; Matsumoto, Harunobu; Kimura, Naoyuki; Yamaguchi, Atsushi

doi:10.1007/s11748-017-0787-8

Cited by 7 publications

(6 citation statements)

References 19 publications

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“…This study and previous study from our group have shown that there was no significant change in PWV in patients receiving Najuta (Hori et al, 2017(Hori et al, , 2020. There are several types of endovascular devices in the market depending on the differences in the fabric used and stent skeleton design.…”

Section: Discussionsupporting

confidence: 44%

Treatment Site Does Not Affect Changes in Pulse Wave Velocity but Treatment Length and Device Selection Are Associated With Increased Pulse Wave Velocity After Thoracic Endovascular Aortic Repair

et al. 2021

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Background: Endovascular treatment of aortic aneurysm is associated with an increase in pulse wave velocity (PWV) after surgery. However, the effect of different types of endovascular devices on PWV at different sites of the thoracic aorta remains unclear.Objectives: The purposes of this study were (1) to investigate the changes in PWV after endovascular treatment of thoracic aortic aneurysm; (2) to evaluate whether there is a difference in the changes in PWV at different treatment sites; and (3) to evaluate the effect of treatment length on changes in PWV.Methods: From July 2008 to July 2021, 276 patients underwent endovascular treatment of the true thoracic aortic aneurysm. Of these patients, 183 patients who underwent preoperative and postoperative PWV measurement within 1 year of surgery were included in the study. The treatment length index was calculated by treatment length divided by the height of the patients.Results: Five different types of endovascular devices were used (Najuta, Kawasumi Laboratories, Inc., Tokyo, Japan; TAG, W.L. Gore & Associates, Inc., AZ, USA; Relay, Bolton Medical, Inc., FL, USA; Talent/Valiant, Medtronic, MN, USA; and Zenith, Cook Medical, IN, USA). There was no significant change in PWV in patients receiving Najuta (Before: 2,040 ± 346.8 cm/s vs. After: 2,084 ± 390.5 cm/s, p = 0.14). However, a significant increase was observed in other devices: TAG (Before: 2,090 ± 485.9 cm/s vs. After: 2,300 ± 512.1 cm/s, p = 0.025), Relay (Before: 2,102 ± 465.3 cm/s vs. After: 2,206 ± 444.4 cm/s, p = 0.004), Valiant (Before: 1,696 ± 330.2 cm/s vs. After: 2,186 ± 378.7 cm/s, p < 0.001), and Zenith (Before: 2,084 ± 431.7 cm/s vs. After: 2,321 ± 500.6 cm/s, p < 0.001). There was a significant increase in PWV in patients treated from aortic arch (Before: 2,006 ± 333.7 cm/s vs. After: 2,132 ± 423.7 cm/s, p < 0.001) and patients treated from descending thoracic aorta (Before: 2,116 ± 460.9 cm/s vs. After: 2,292 ± 460.9 cm/s, p < 0.001). Multivariate analysis showed that treatment site was not an independent factor associated with changes in PWV. However, Najuta (Coef −219.43, 95% CI −322.684 to −116.176, p < 0.001) and treatment index (Coef 147.57, 95% CI 24.826 to 270.312, p = 0.019) were independent factors associated with changes in PWV.Conclusion: Najuta did not show a significant increase in PWV, while other commercially available devices showed a significant increase. The treatment site did not have a different effect on PWV. However, the treatment length was an independent factor associated with an increase in PWV.

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Section: Discussionsupporting

confidence: 44%

Treatment Site Does Not Affect Changes in Pulse Wave Velocity but Treatment Length and Device Selection Are Associated With Increased Pulse Wave Velocity After Thoracic Endovascular Aortic Repair

et al. 2021

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“…10) Aortic stiffness and compliance is associated with atherosclerosis, which has also been reported to increase with age. 11) Our findings of increased age and prevalence of cerebral vascular disease may be associated with greater compliance of the vascular system, which may result in enhanced enlargement of the prosthetic graft. 10) Although limited in sample size, our data has also shown a possible correlation between the graft dilation ratio and postoperative PWV measurement, which is a measure for aortic stiffness.…”

Section: Discussionmentioning

confidence: 74%

Prosthetic Graft Dilation at the Aortic Arch in the Era of Hybrid Aortic Surgery

Hori

Kusadokoro

Shimizu

et al. 2020

Annals of Vascular Diseases

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Objective: This study aims to evaluate the chronological size changes of the prosthetic graft in the aortic arch, which is used as a landing zone for a subsequent stent grafting in hybrid aortic surgery. Materials and Methods: Eighty-five patients who underwent total aortic arch replacement followed by computed tomography follow-up for at least 30 months after the surgery were included in the study. Results: Prosthetic grafts used were Hemashield (Maquet, Rastatt, Germany), J-Graft (Japan Lifeline Inc., Tokyo, Japan) and Triplex (Terumo, Tokyo, Japan). There was an initial increase in diameter compared to package size after implantation (Hemashield, 1.04±0.035 vs. J-Graft, 1.06±0.027 vs. Triplex, 1.04±0.023, p=0.13). Significant difference in graft dilation ratio was observed in Triplex (1.18±0.062) at long-term compared to Hemashield (1.07±0.052, p<0.001) and J-Graft (1.10±0.071, p<0.001). Multivariate analysis showed that age (r=0.002; 95% confidence interval [CI], 0.0001-0.0037; p=0.035), knitted-type prosthesis (r=0.089; 95% CI, 0.0610-0.1163; p<0.0001), and prevalence of cerebral vascular disease (r=0.038; 95% CI, 0.0030-0.0732; p=0.034) were independently associated with graft dilation after surgery. Conclusion: Prosthetic graft selection and appropriate sizing of the stent graft should be considered for each individual undergoing hybrid aortic surgery to maintain sufficient oversizing of the stent graft.

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“… 27 Hori et al suggest that endoskeleton (stents are mounted inside graft fabric) stent-graft design may allow for aneurysm repair with minimal impact on PWV, thereby reducing the risk of end-organ damage following endovascular repair. 28 Adding to their suggestion, in 2020 30 they compared exoskeleton (metallic stents are mounted outside graft fabric) to endoskeleton endografts, highlighting that postoperatively exoskeleton endografts significantly increased PWV in patients undergoing TEVAR for aortic arch aneurysm, while patients who received an endoskeleton-type endograft experienced a significantly lower risk of cardiac and cerebrovascular events. This was also linked to changes of diastolic dysfunction markers.…”

Section: Resultsmentioning

confidence: 99%

“…The review identified 10 studies (Table 3) reporting the influence of thoracic endografts, following TEVAR, on arterial stiffness. [27][28][29][30][31][32][33][34][35][36] Most studies on TEVAR utilized PWV to measure arterial stiffness. 27,28,30,33,35 In 2017, PWV was used for measuring the arterial stiffness in patients following TEVAR for descending thoracic aorta disease, showing remarkable increase 6 months postoperatively.…”

Section: Studies Assessing Arterial Stiffness In Patients With Taa Be...mentioning

confidence: 99%

Arterial Stiffness and Aortic Aneurysmal Disease – A Narrative Review

Moulakakis,

Pitros,

Theodosopoulos

et al. 2024

VHRM

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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.

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Effect of endoskeleton stent graft design on pulse wave velocity in patients undergoing endovascular repair of the aortic arch

Abstract: Physiological changes after endovascular treatment should be considered including effect on vascular stiffness. Endoskeleton stent graft may provide aneurysm repair with minimum effect in PWV after surgery.

Cited by 7 publications

References 19 publications

Treatment Site Does Not Affect Changes in Pulse Wave Velocity but Treatment Length and Device Selection Are Associated With Increased Pulse Wave Velocity After Thoracic Endovascular Aortic Repair

Treatment Site Does Not Affect Changes in Pulse Wave Velocity but Treatment Length and Device Selection Are Associated With Increased Pulse Wave Velocity After Thoracic Endovascular Aortic Repair

Prosthetic Graft Dilation at the Aortic Arch in the Era of Hybrid Aortic Surgery

Arterial Stiffness and Aortic Aneurysmal Disease – A Narrative Review

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