Objective
Increased aortic stiffness (AoS) has been recognised as a risk factor in the development
of cardiovascular disease. The aim of this systematic review and meta-analysis was
to assess the impact of aortic repair on AoS.
Data Sources
PubMed, Scopus, and Web of Science were searched systematically for relevant studies
evaluating the consequences of endovascular and open aortic repair on AoS.
Review Methods
The Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P)
statement was followed to perform the research process. Papers containing data on
AoS before and after both thoracic (TEVAR) and abdominal (EVAR) endovascular repair,
as well as open surgical repair (OSR), were included for detailed evaluation. A fixed
effects model was used to perform analysis. The Newcastle–Ottawa Scale was calculated
for each included study.
Results
The first article cluster comprised 367 papers. After removal of duplicates and the
adoption of inclusion/exclusion criteria, 14 articles remained, 13 of which were selected
for meta-analysis. Ten studies analysed EVAR and three analysed TEVAR. Five of the
selected papers were case control studies, with OSR adopted in four of these as the
EVAR comparator. Several graft types were used in the endovascular group. AoS increased
after TEVAR and EVAR, in terms of pulse wave velocity (PWV), even though several spatial
levels and measurement modalities were adopted. No differences were described after
OSR, although no pooled data could be analysed.
Conclusion
EVAR and TEVAR both demonstrated a significant increase in AoS measurement (PWV).
Although the heterogeneity and the low number of available studies limit the strength
of the results, this review highlights the potential deleterious endograft role in
the cardiovascular system although further studies are needed to achieve robust evidence.
Further studies are needed to improve the mutual interaction between aorta and endograft,
minimising their impact on the native aortic wall properties.
Keywords
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Article info
Publication history
Published online: March 10, 2022
Accepted:
January 16,
2022
Received:
July 20,
2021
Identification
Copyright
© 2022 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.
