Postendovascular Aneurysmal Repair Increase in Local Energy Loss for Fusiform Abdominal Aortic Aneurysm: Assessments With 4D flow MRI

Background Although endovascular aneurysmal repair (EVAR) is a preferred treatment for abdominal aortic aneurysm (AAA) owing to its low invasiveness, its impact on the local hemodynamics has not been fully assessed. Purpose To elucidate how EVAR affects the local hemodynamics in terms of energy loss (EL). Study Type Prospective single-arm study. Field Strength/Sequence A 3.0 T/4D flow MRI using a phase-contrast three-dimensional cine-gradient-echo sequence. Population A total of 13 consecutive patients (median [interquartile range] age: 77.0 [73.0, 78.8] years, 11 male) scheduled for EVAR as an initial treatment for fusiform AAA. Assessment 4D flow MRI covering the abdominal aorta and bilateral common iliac arteries and the corresponding stent-graft (SG) lumen was performed before and after EVAR. Plasma brain natriuretic peptide (BNP) was measured within 1 week before and 1 month after EVAR. The hemodynamic data, including mean velocity and the local EL, were compared pre-/post-EVAR. EL was correlated with AAA neck angle and with BNP. Patients were subdivided into deformed (N = 5) and undeformed SG subgroups (N = 8) and pre-/post-EVAR BNP compared in each. Statistics Parametric or nonparametric methods. Spearman's rank correlation coefficients (r). The interobserver/intraobserver variabilities with Bland-Altman plots. A P value < 0.05 is considered significant. Results The mean velocity (cm/sec) at the AAA was five times greater after EVAR: 4.79 +/- 0.32 vs. 0.91 +/- 0.02. The total EL (mW) increased by 1.7 times after EVAR: 0.487 (0.420, 0.706) vs. 0.292 (0.192, 0.420). The total EL was proportional to the AAA neck angle pre-EVAR (r = 0.691) and post-EVAR (r = 0.718). BNP (pg/mL) was proportional to the total EL post-EVAR (r = 0.773). In the deformed SG group, EL (0.349 [0.261, 0.416]) increased 2.4-fold to 0.848 (0.597, 1.13), and the BNP 90.3 (53.6, 105) to 100 (67.2, 123) post-EVAR. Conclusion The local EL showed a 1.7-fold increase after EVAR. The larger increase in the EL in the deformed SG group might be a potential concern for frail patients. Evidence Level 1 Technical Efficacy Stage 2

Automated summary

The aim of this study was to investigate the impact of endovascular aneurysmal repair (EVAR) on the local hemodynamics of abdominal aortic aneurysm (AAA). The results showed a 1.7-fold increase in local energy loss (EL) after EVAR, with a greater increase in the deformed stent-graft subgroup. These findings could be a potential concern for frail patients.