What is the clinical evidence from this study?

Study design: Cohort. Population: Abdominal aortic aneurysm (n=265). Intervention: Endovascular aneurysm repair (EVAR). Primary outcome: 2-year all-cause mortality (per 1-SD increase in change of carotid-femoral pulse wave velocity) (HR 4.011, 95% CI 1.154-13.950, p=0.029).

What does this research mean for the field?

An increase in carotid-femoral pulse wave velocity following endovascular aneurysm repair is an independent predictor of 2-year all-cause mortality, and specific stent materials influence both these hemodynamic changes and mortality rates. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This research examines how different stent-graft materials affect arterial stiffness and outcomes in patients treated for abdominal aortic aneurysm using endovascular repair.

April 1, 2026Open Access

Impact of stent materials and hemodynamic changes after endovascular aneurysm repair for abdominal aortic aneurysm

Resultado clave

An increase in carotid-femoral pulse wave velocity following endovascular aneurysm repair was an independent predictor of 2-year all-cause mortality (HR 4.011).

Puntos clave

This research examines how different stent-graft materials affect arterial stiffness and outcomes in patients treated for abdominal aortic aneurysm using endovascular repair.
Evaluated patients with abdominal aortic aneurysm undergoing EVAR
Measured hemodynamic parameters before and one month after EVAR
Used statistical analysis to compare mortality rates and changes in arterial stiffness between different stent materials
Carotid-femoral pulse wave velocity (cf-PWV) increased significantly one month post-EVAR
Mortality was higher in patients with nitinol compared to stainless steel stents and Dacron compared to PTFE at 2-year follow-up
Changes in cf-PWV were an independent predictor of mortality with a hazard ratio of 4.011

Diseño del estudio

Tipo

Cohort (n=265)

Multicéntrico

PICO estructurado

Does the choice of stent material and fabric affect arterial stiffness and mortality in patients with abdominal aortic aneurysm undergoing EVAR?

Población

Patients with abdominal aortic aneurysm (AAA) undergoing endovascular aortic repair (EVAR), excluding acute aortic syndrome, active malignancy, or non-sinus rhythm; mean age 75.1 years, 88.3% male.

Intervención

Nitinol stents and/or Dacron stent-graft fabrics

Comparador

Stainless-steel stents and/or PTFE stent-graft fabrics

Resultado

Changes in pulsatile hemodynamics (cf-PWV, cAI, Pb) at 1 month and all-cause mortality up to 2 years post-dischargehard clinical

In patients undergoing EVAR for abdominal aortic aneurysm, the use of nitinol stents and Dacron fabrics is associated with increased arterial stiffness and higher 2-year mortality compared to stainless-steel stents and PTFE fabrics.

Resultado numérico

Estimación del efecto: HR 4.011 (95% CI 1.154-13.950)

valor p: p=0.029

Limitaciones

Sample size may limit the generalizability of the findings to the broader EVAR population
Pulsatile hemodynamics were assessed only at baseline and 1 month
Detailed anatomic and clinical determinants of device selection were not systematically collected
Sample size or power calculation was not performed as this study was an observational cohort

Resumen

Abstract Endovascular aortic repair (EVAR) treatment was associated with increase in arterial stiffness following the procedure abdominal aortic aneurysm (AAA). This study aims to investigate the impact of different stent-graft materials on arterial stiffness measurements and the outcomes of AAA patients undergoing EVAR. Patients with AAA undergoing EVAR were eligible for this study. Pulsatile hemodynamic parameters, including carotid-femoral pulse wave velocity (cf-PWV), carotid augmentation index (cAI), and backward pressure amplitude (Pb), were measured before and 1 month after the EVAR procedure. All-cause mortality up to 2 years post-discharge was determined by linking the study population to the National Death Registry. Among a total of 265 study participants (age 75.1 ± 11.7 years, 88.3% men), the length and diameter of the aneurysm were 7.95 ± 2.61 cm and 5.88 ± 2.08 cm, respectively. One month after EVAR, cf-PWV significantly increased, and only cf-PWV showed a significant between-group difference among stainless-steel and nitinol stent group after adjusting for MBP. At the 2-year follow-up, mortality was significantly higher in the nitinol vs. stainless-steel group and the Dacron vs. PTFE group. Furthermore, changing of cf-PWV following EVAR was an independent predictor of mortality hazard ratio (HR) per 1-SD and 95% confidence interval (CI): 4.011 (1.154–13.950), p = 0.029 after accounting for confounding factors. The stent materials and fabric may influence the change of pulsatile hemodynamics after EVAR. Higher mortality rates were observed in those treated with Dacron fabric and nitinol stents, and Δcf-PWV was an independent predictor of mortality.

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