title: Influence of pulmonary status and diabetes mellitus on aortic neck dilatation following endovascular repair of abdominal aortic aneurysms: a EUROSTAR report.
abstract: OBJECTIVE
  To elucidate the association of impaired pulmonary status (IPS) and diabetes mellitus (DM) with clinical outcome and the incidences of aortic neck dilatation and type I endoleak after elective endovascular infrarenal aortic aneurysm repair (EVAR).
  
  
  METHODS
  In 164 European institutions participating in the EUROSTAR registry, 6383 patients (5985 men; mean age 72.4+/-7.6 years) underwent EVAR. Patients were divided into patients without versus with IPS or with/without DM. Clinical assessment and contrast-enhanced computed tomography (CT) were performed at 1, 3, 6, 12, 18, and 24 months and annually thereafter. Cumulative endpoint analysis comprised death, aortic rupture, type I endoleak, endovascular reintervention, and surgical conversion.
  
  
  RESULTS
  Prevalence of IPS was 2733/6383 (43%) and prevalence of DM was 810/6383 (13%). Mean follow-up was 21.1+/-18.4 months. Thirty-day mortality, AAA rupture, and conversion rates did not differ between patients with versus without IPS and between patients with versus without DM. All-cause and AAA-related mortality, respectively, were significantly higher in patients with IPS compared to patients with normal pulmonary status (31.0% versus 19.0%, p<0.0001 and 6.8% versus 3.3%, p = 0.0057) throughout follow-up. In multivariate analysis adjusted for smoking, age, gender, comorbidities, fitness for open repair, co-existing common iliac aneurysm, neck and aneurysm size, arterial angulations, aneurysm classification, endograft oversizing >or=15%, and type of stent-graft, the presence of IPS was not associated with significantly higher rates of aortic neck dilatation (30.6% versus 38.0%, p>0.05) and did not influence cumulative rates of type I endoleak, endovascular reintervention, or conversion to open surgery (p>0.05). Similarly, the presence of DM did not influence the above-mentioned study endpoints.
  
  
  CONCLUSIONS
  In contrast to observations regarding the natural course of AAAs, impaired pulmonary status does not negatively influence aortic neck dilatation, while the presence of diabetes does not protect from these dismal events after EVAR.
authors.affiliation: Division of Angiology, Swiss Cardiovascular Centre, University Hospital, (Inselspital), Bern, Switzerland. nicolas.diehm@insel.ch
authors.forename: Nicolas
authors.initials: N
authors.lastname: Diehm
authors.forename: Roel
authors.initials: R
authors.lastname: Hobo
authors.forename: Iris
authors.initials: I
authors.lastname: Baumgartner
authors.forename: Dai-Do
authors.initials: DD
authors.lastname: Do
authors.forename: Hak-Hong
authors.initials: HH
authors.lastname: Keo
authors.forename: Christoph
authors.initials: C
authors.lastname: Kalka
authors.forename: Florian
authors.initials: F
authors.lastname: Dick
authors.forename: Jaap
authors.initials: J
authors.lastname: Buth
authors.forename: Juerg
authors.initials: J
authors.lastname: Schmidli
mesh_terms: D000368:Aged; D001012:Aorta, Abdominal / Q000473:pathology / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001019:Aortic Rupture / Q000209:etiology* / Q000401:mortality; D001027:Aortography; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000706:statistics & numerical data; D003920:Diabetes Mellitus / Q000453:epidemiology; D004108:Dilatation, Pathologic / Q000209:etiology / Q000473:pathology; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008171:Lung Diseases / Q000150:complications* / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012042:Registries; D012086:Reoperation; D012107:Research Design; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure; D016896:Treatment Outcome