The detrimental effects of endovascular aneurysm repair on aortic compliance

Objective: Endovascular aneurysm repair (EVAR) constitutes the cornerstone of contemporary abdominal aortic aneurysm (AAA) treatment, owing to superior short-term outcomes in comparison with open surgical repair (OSR).However, this difference is offset by unfavorable long-term outcomes.EVAR may detrimentally affect aortic compliance, with significant subsequent consequences.We sought to elucidate the natural history of this phenomenon. Methods:We conducted a nonrandomized, prospective study of 140 consecutive patients undergoing elective EVAR or OSR for abdominal aortic aneurysm.Aortic stiffness was measured preoperatively (T0), within 1 week of the operation (T1), 4 to 6 weeks (T2), and at 1 year (T3), using a validated noninvasive device (Vicorder) to measure carotid-femoral pulse wave velocity (cfPWV) and brachial-femoral pulse wave velocity (bfPWV), as well as central pulse pressure.Repeated measures analysis of variance was applied to the hemodynamic measurements to quantify changes along time.Results: Of 140 patients, 130 (93%) underwent EVAR.EVAR resulted in a significant increase in carotid-femoral pulse wave velocity (T0, 9.9 1.3 m/s; T1, 11.0 1.6 m/s; T2, 12.2 3.8 m/s; and T3, 12.5 2.6 m/s; P < .05for the comparison with T0), bfPWV (T0, 34.6 12 mm Hg; T1, 40.4 12.4 mm Hg; T2, 44.2 14.6 mm Hg; and T3, 44.3 12.6 mm Hg; P < .05for the comparison with T0), and central pulse pressure (T0, 59 12 mm Hg; T1, 61 12 mm Hg; T2, 63 13; and T3, 64 12 mm Hg mm Hg; P < .05for the comparison of T2 and T3 with T0).There were no significant differences across all timepoints for those having OSR. Conclusions:In this study, the first to use bfPWV in this context, EVAR, but not OSR, significantly decreased aortic compliance, not only immediately post intervention, but steadily over 1 year.(JVS-Vascular Insights 2026;:100344.