Impact of stent materials and hemodynamic changes after endovascular aneurysm repair for abdominal aortic aneurysm

Endovascular aortic repair (EVAR) treatment was associated with increase in arterial stiffness following the procedure abdominal aortic aneurysm (AAA). This study aims to investigate the impact of different stent-graft materials on arterial stiffness measurements and the outcomes of AAA patients undergoing EVAR. Patients with AAA undergoing EVAR were eligible for this study. Pulsatile hemodynamic parameters, including carotid-femoral pulse wave velocity (cf-PWV), carotid augmentation index (cAI), and backward pressure amplitude (Pb), were measured before and 1 month after the EVAR procedure. All-cause mortality up to 2 years post-discharge was determined by linking the study population to the National Death Registry. Among a total of 265 study participants (age 75.1 ± 11.7 years, 88.3% men), the length and diameter of the aneurysm were 7.95 ± 2.61 cm and 5.88 ± 2.08 cm, respectively. One month after EVAR, cf-PWV significantly increased, and only cf-PWV showed a significant between-group difference among stainless-steel and nitinol stent group after adjusting for MBP. At the 2-year follow-up, mortality was significantly higher in the nitinol vs. stainless-steel group and the Dacron vs. PTFE group. Furthermore, changing of cf-PWV following EVAR was an independent predictor of mortality [hazard ratio (HR) per 1-SD and 95% confidence interval (CI): 4.011 (1.154-13.950), p = 0.029] after accounting for confounding factors. The stent materials and fabric may influence the change of pulsatile hemodynamics after EVAR. Higher mortality rates were observed in those treated with Dacron fabric and nitinol stents, and Δcf-PWV was an independent predictor of mortality. In AAA patient underwent EVAR, nitinol stent was associated with a significant increase in cf-PWV after EVAR. Higher mortality rates were observed in nitinol stents, and changes in cf-PWV was an independent predictor of mortality.