Thaxton Carly, Kano Masaki, Mendes-Pinto Daniel, Navarro Túlio Pinho, Nishibe Toshiya, Dardik Alan
Departments of Surgery and the Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, CT.
Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan.
JVS Vasc Sci. 2024 May 21;5:100209. doi: 10.1016/j.jvssci.2024.100209. eCollection 2024.
Arterial stiffening is associated with adverse cardiovascular patient outcomes; stiffness may also be associated with postsurgical events and has been suggested to be a fundamental mechanism in the pathogenesis of aortic aneurysms. Although open repair of aneurysms decreases aortic stiffness, implantation of a rigid endograft is associated with increased aortic stiffness after endovascular aneurysm repair (EVAR). This review provides an overview of aortic wall physiology and the contemporary understanding of aortic stiffness and its implications for patients undergoing abdominal aortic aneurysm repair. Recent data suggests that increased central arterial stiffness, estimated preoperatively using the pulse wave velocity (PWV), may predict aneurysm sac behavior after EVAR, with elevated preoperative PWV associated with less sac shrinkage, and even sac enlargement, after EVAR. With the development of several simple noninvasive methods to measure PWV, such as brachial-ankle PWV and single cuff brachial oscillometry, there may be a role for monitoring ambulatory PWV to predict outcomes after EVAR. Additionally, because aortic stiffness is associated with adverse cardiovascular outcomes, and EVAR increases aortic stiffness, assessment of aortic stiffness before aortic interventions may help to guide therapeutic decisions as well as surveillance protocols, leading to optimized patient outcomes.
动脉僵硬度与心血管疾病患者的不良预后相关；僵硬度还可能与术后事件有关，并且被认为是主动脉瘤发病机制中的一个基本机制。尽管动脉瘤开放修复可降低主动脉僵硬度，但在血管内动脉瘤修复术（EVAR）后，植入刚性血管内支架移植物与主动脉僵硬度增加有关。本综述概述了主动脉壁生理学以及对主动脉僵硬度的当代认识及其对接受腹主动脉瘤修复术患者的影响。最近的数据表明，术前使用脉搏波速度（PWV）估计的中心动脉僵硬度增加可能预测EVAR后动脉瘤囊的变化，术前PWV升高与EVAR后囊袋缩小较少甚至囊袋扩大有关。随着几种简单的无创测量PWV方法的发展，如臂踝PWV和单袖带臂部示波法，监测动态PWV可能有助于预测EVAR后的结果。此外，由于主动脉僵硬度与不良心血管结局相关，且EVAR会增加主动脉僵硬度，在主动脉干预前评估主动脉僵硬度可能有助于指导治疗决策以及监测方案，从而优化患者结局。
