title: C-reactive protein predicts aortic aneurysmal disease progression after endovascular repair.
abstract: OBJECTIVE
  This study aims to investigate the prognostic significance of the rate of variation of C-reactive protein (CRP) levels as a predictor of aneurysmal sac and neck expansion and, therefore, of aneurysm disease progression, in patients undergoing endovascular aneurysm repair (EVAR) in the absence of endoleaks.
  
  
  METHODS
  192 patients following non-emergency elective EVAR for asymptomatic infra-renal abdominal aorta aneurysm (AAA) were included after a six-month period after intervention to ensure the treatment success and absence of endoleaks. Expansion of aneurysm sac or neck after the six-month stabilization term occurred in 120 (63%) and 128 (67%) patients for a mean follow-up of 53±23 months.
  
  
  RESULTS
  The relative CRP plasma level gradient significantly differed between the subgroups of patients according to relative sac expansion quartiles (7%, 26%, 39%, and 61%; p<0.001). In the bivariate analysis, the aorta sac diameter expansion rate progressively increased in the subgroups determined by CRP gradient quartiles (-0.5±1%, 3.6±1%, 8±2%, 10±3%; p<0.01). The median (25th; 75th quartile) CRP level rise in "rapid expanders" patients (those above the median annual sac expansion rate of 5.7%) was 51% (37%; 67%) compared with 15% (3%; 28%) in "slow- or non-expanders" (p<0.001). The multivariate age-adjusted logistic model confirmed the variation of CRP level and neck length as the only factors independently associated to sac expansion (odds ratio 4.3; 95% CI: 2.3-7.9 and 1.7; 95% CI: 1.3-2.2, respectively).
  
  
  CONCLUSIONS
  There is a significant time-related association between AAA sac diameter enlargement and CRP plasma level gradient after EVAR in the absence of endoleaks, confirming the latter as a proper marker of aneurysm disease progression and rate of expansion in these patients.
authors.affiliation: Angiology and Vascular Surgery Department, Hospital Universitario Getafe, Madrid, Spain. Electronic address: deharojoaquin@yahoo.es.
authors.forename: Joaquin
authors.initials: J
authors.lastname: De Haro
authors.affiliation: Angiology and Vascular Surgery Department, Hospital Universitario Getafe, Madrid, Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: Bleda
authors.affiliation: Angiology and Vascular Surgery Department, Hospital Universitario Getafe, Madrid, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Acin
mesh_terms: D000368:Aged; D000792:Angiography; D017544:Aortic Aneurysm, Abdominal / Q000097:blood* / Q000175:diagnosis / Q000601:surgery; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D018450:Disease Progression; D017558:Elective Surgical Procedures / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011184:Postoperative Period; D011379:Prognosis; D013997:Time Factors; D036542:Tomography, Spiral Computed
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein
keywords: Abdominal aorta aneurysm; Aneurysm disease; C-reactive protein; EVAR; Endovascular; Inflammation