title: Endovascular aortic repair increases vascular stiffness and alters cardiac structure and function.
abstract: BACKGROUND
  Endovascular aortic repair (EVAR) is performed in patients with thoracic or abdominal aortic aneurysm because it is less invasive than conventional open repair. However, the effects of EVAR on vascular and cardiac function remain to be clarified.
  
  
  RESULTS
  We studied the effects of EVAR on several outcome variables in 40 consecutive patients undergoing EVAR for abdominal and/or thoracic aneurysm with preserved ejection fraction. Echocardiography and brachial-ankle pulse wave velocity (baPWV) data were collected before, 1 week, and 1 year after EVAR. Although no changes in blood pressure were found, baPWV, left ventricular mass index (LVMI), and left atrial volume index were significantly elevated at both post-op time periods after EVAR compared with baseline data. The changes in LVMI correlated with those in baPWV (R=0.32, P<0.05). Among the 22 patients who were successfully followed up, 13 showed deterioration in exercise tolerance 1 year after EVAR. Diastolic wall strain, an index for LV distensibility, was lower at baseline in patients with worsening exercise tolerance than in those with unchanged tolerance.
  
  
  CONCLUSIONS
  EVAR increased vascular stiffness and induced LV hypertrophy and diastolic dysfunction without a corresponding elevation of blood pressure in the acute and chronic phases. In addition, low LV distensibility at baseline was associated with the impairment of exercise tolerance. EVAR-induced stiffness of arteries leads to limited clinical symptoms.
authors.affiliation: Departments of Cardiovascular Medicine, Osaka University Graduate School of Medicine.
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Takeda
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Sakata
authors.forename: Tomohito
authors.initials: T
authors.lastname: Ohtani
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Tamaki
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Omori
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Tsukamoto
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Aizawa
authors.forename: Kazuo
authors.initials: K
authors.lastname: Shimamura
authors.forename: Yukitoshi
authors.initials: Y
authors.lastname: Shirakawa
authors.forename: Toru
authors.initials: T
authors.lastname: Kuratani
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Sawa
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Yamamoto
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Mano
authors.forename: Issei
authors.initials: I
authors.lastname: Komuro
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty; D017544:Aortic Aneurysm, Abdominal / Q000473:pathology / Q000503:physiopathology* / Q000628:therapy*; D017545:Aortic Aneurysm, Thoracic / Q000503:physiopathology* / Q000628:therapy*; D001794:Blood Pressure; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008297:Male; D059289:Vascular Stiffness; D016277:Ventricular Function, Left