Impact of the Aortic Graft on Arterial Stiffness and Inflammatory Biomarkers after Endovascular Aortic Repair or Open Surgical Repair in Abdominal Aortic Aneurysm Disease

Background Abdominal aortic aneurysm (AAA) is an important cardiovascular (CV)-related disease that requires surgical treatment to prevent rupture. The elevation of arterial stiffness (AS) is an increasingly recognized independent determinant of CV morbidity and mortality and plays a special role in atherosclerosis. The importance of the surgical technique used for AAA repair in the long-term outcomes still needs to be clarified, and whether endovascular aortic repair (EVAR) or open surgical repair (OSR) confers high AS measurements and thus worse prognosis in terms of CV morbidity needs further investigation. Methods A prospective nonrandomized study that included consecutive patients requiring either EVAR or OSR for AAA disease between February 2015 and January 2016 was conducted. This study is registered on the National Institutes of Health website ( ClinicalTrials.gov ) and identified with NCT02642952. Several noninvasive measurements of AS and central aortic hemodynamics were obtained before surgery and in the first postoperative control (4–6 weeks), with change from baseline in heart rate–adjusted augmentation index (AIx@75) as main outcome. Likewise, inflammatory circulating biomarkers were also measured in the same time line. Results We included 44 patients, 25 in the EVAR group and 19 in the OSR group. Subjects who underwent EVAR were older and presented larger aneurysm diameter at baseline. There was a significant decrease in AIx@75 in the EVAR group after treatment (−4.1 ± 8.1%, P  = 0.018), for a moderate effect size (d = 0.508), whereas the decreasing trend in the OSR group (−2.5 ± 6.7%, P  = 0.127) was not statistically significant. No significant changes in carotid-radial pulse wave velocity (PWV CR ) and central blood pressures were observed. The inflammatory markers increased after surgical repair, with significant changes in homocysteine in both EVAR (5.2 ± 6.9 μmol/L, P  = 0.002) and OSR (1.8 ± 2.1 μmol/L, P  = 0.002) groups. Conclusions Our study suggests that both treatments confer better postoperative values of AS measured by AIx@75 and produces no changes in PWV CR , in the early term. Whether this situation is maintained during follow-up needs further investigation.