Association Between Abdominal Aortic Diameter and Major Cardiovascular and Cerebrovascular Events After Infrarenal Endovascular Aortic Aneurysm Repair

Vollständiger Abstract

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Background: Major adverse cardiovascular and cerebrovascular events (MACCE) following endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAAs) are serious outcomes. The primary aim of this study was to evaluate the incidence of MACCE after EVAR and to investigate the relevant predictive factors for MACCE. Materials and Methods: This single-center retrospective cohort study included patients who were diagnosed with infrarenal AAAs and who underwent EVAR from February 2012 to February 2022. The cumulative incidence of MACCE after EVAR in this study was assessed via a competing-risk model. Results: This study included 1090 patients with AAAs who underwent EVAR. Multivariate analyses revealed that the maximum diameter of the AAA may be an independent predictor of MACCE after EVAR (hazard ratio per 10-mm increase = 1.219; 95% confidence interval [CI] = 1.072-1.397; P = .002). During a median follow-up of 42 months, 323 patients experienced at least 1 MACCE, whereas 767 patients did not experience MACCE. The cumulative risks of MACCE excluding noncardiovascular/noncerebrovascular mortality at 12, 36, and 60 months after EVAR were 5.4%, 9.1%, and 19.0%, respectively. Conclusion: The cumulative incidence of MACCE after EVAR for AAAs is relatively high, and the maximum diameter of the AAAs is a predictor of MACCE. Clinical Impact Major adverse cardiovascular and cerebrovascular events remain an important long-term concern after EVAR. In this large retrospective cohort, approximately one in five patients experienced MACCE within 5 years, after accounting for competing noncardiovascular/noncerebrovascular mortality. Importantly, larger maximum AAA diameter was independently associated with a higher risk of subsequent MACCE. These findings suggest that aneurysm diameter may provide additional information for cardiovascular risk stratification beyond its established role in determining aneurysm-related treatment. Patients with larger AAAs may therefore warrant closer cardiovascular surveillance and more intensive management of modifiable risk factors after EVAR.