[en] Background: Diabetes has a protective effect on abdominal aortic aneurysms (AAAs); however, there are contrasting reports on the impact of diabetes on endovascular aortic repair (EVAR) outcomes, endoleaks (ELs) being the major negative outcome. The present study characterizes ELs and their outcomes in AAA patients, diabetic or not. Methods: This single-center, retrospective, comparative study was carried out on 324 AAA patients who underwent elective EVARs between 2007 and 2016 at the University Hospital of Liège (Belgium). The primary endpoint was the incidence and effect of ELs on the evolution of the aneurysmal sac; the secondary endpoints were surgical reintervention and mortality rate. Diabetic and non-diabetic patients were compared with respect to various risk factors by logistic regression, while a Cox regression was used to analyze survival. Results: In AAA patients meeting the inclusion criteria (n = 248), 23% were diabetic. EL incidence was comparable (p = 0.74) in diabetic (38.7%) vs. non-diabetic (43.9%) patients. EL risk factors were age (HR = 1.04, p = 0.014) and fibrate intake (HR = 3.12, p = 0.043). A significant association was observed between ELs and aneurysm sac enlargement (p < 0.001), regardless of group (p = 0.46). Aneurysm sac regression per month for non-diabetic patients was −0.24 ± 0.013, while for diabetics it was −0.18 ± 0.027 (p = 0.059). Dyslipidemia (HR = 3.01, p = 0.0060) and sulfonylureas (HR = 8.43, p = 0.043) were associated with shorter EL duration, while diabetes (HR = 0.080, p = 0.038) and beta blockers (HR = 0.46, p = 0.036) were associated with longer EL duration. The likelihood of reoperation decreased with more recent surgery (OR = 0.90, p = 0.040), regardless of diabetic status. All-cause mortality was higher for the non-diabetic group (45.5% vs. 26.3%, p = 0.0096). Conclusions: Endoleak occurrence is a known risk factor for sac expansion. In diabetic patients, endoleaks lasted longer, and regression of the aneurysm sac tended to be slower. The number and type of reintervention was not related to the diabetic status of AAA patients, but overall survival was higher in patients with diabetes.
Disciplines :
Surgery
Author, co-author :
Praca, Charlotte ; Centre Hospitalier Universitaire de Liège - CHU > > Service de chirurgie cardio-vasculaire et thoracique
Sakalihasan, Natzi ; Université de Liège - ULiège > Département des sciences cliniques
Defraigne, Jean-Olivier ; Université de Liège - ULiège > Département des sciences cliniques > Chirurgie cardio-vasculaire et thoracique
Labropoulos, Nicos ; Department of Surgery, Stony Brook University Hospital, Stony Brook, NY 11794-8191, USA
Albert, Adelin ; Université de Liège - ULiège > Département des sciences de la santé publique
Seidel, Laurence ; Université de Liège - ULiège > Département des sciences de la santé publique
MUSUMECI, Lucia ; Centre Hospitalier Universitaire de Liège - CHU > > Service de chirurgie cardio-vasculaire et thoracique
Language :
English
Title :
Endovascular Treatment of Abdominal Aortic Aneurysm: Impact of Diabetes on Endoleaks and Reintervention
Chuter T.A.M. Faruqi R.M. Sawhney R. Reilly L.M. Kerlan R.B. Canto C.J. Lukaszewicz G.C. LaBerge J.M. Wilson M.W. Gordon R.L. et al. Endoleak after Endovascular Repair of Abdominal Aortic Aneurysm J. Vasc. Surg. 2001 34 98 105 10.1067/mva.2001.111487 11436081
Brountzos E. Karagiannis G. Panagiotou I. Tzavara C. Efstathopoulos E. Kelekis N. Risk Factors for the Development of Persistent Type II Endoleaks after Endovascular Repair of Infrarenal Abdominal Aortic Aneurysms Diagn. Interv. Radiol. 2011 18 307 313 10.4261/1305-3825.DIR.4646-11.1
Hall M.R. Protack C.D. Assi R. Williams W.T. Wong D.J. Lu D. Muhs B.E. Dardik A. Metabolic Syndrome Is Associated with Type II Endoleak after Endovascular Abdominal Aortic Aneurysm Repair J. Vasc. Surg. 2014 59 938 943 10.1016/j.jvs.2013.10.081
Veith F.J. Baum R.A. Ohki T. Amor M. Adiseshiah M. Blankensteijn J.D. Buth J. Chuter T.A.M. Fairman R.M. Gilling-Smith G. et al. Nature and Significance of Endoleaks and Endotension: Summary of Opinions Expressed at an International Conference J. Vasc. Surg. 2002 35 1029 1035 10.1067/mva.2002.123095
Chaikof E.L. Dalman R.L. Eskandari M.K. Jackson B.M. Lee W.A. Mansour M.A. Mastracci T.M. Mell M. Murad M.H. Nguyen L.L. et al. The Society for Vascular Surgery Practice Guidelines on the Care of Patients with an Abdominal Aortic Aneurysm J. Vasc. Surg. 2018 67 2 77.e2 10.1016/j.jvs.2017.10.044
Rokosh R.S. Wu W.W. Schermerhorn M. Chaikof E.L. Society for Vascular Surgery Implementation of Clinical Practice Guidelines for Patients with an Abdominal Aortic Aneurysm: Postoperative Surveillance after Abdominal Aortic Aneurysm Repair J. Vasc. Surg. 2021 74 1438 1439 10.1016/j.jvs.2021.04.037
Guo Q. Du X. Zhao J. Ma Y. Huang B. Yuan D. Yang Y. Zeng G. Xiong F. Prevalence and Risk Factors of Type II Endoleaks after Endovascular Aneurysm Repair: A Meta-Analysis PLoS ONE 2017 12 e0170600 10.1371/journal.pone.0170600 28182753
Hoshina K. Ishimaru S. Sasabuchi Y. Yasunaga H. Komori K. Outcomes of Endovascular Repair for Abdominal Aortic Aneurysms: A Nationwide Survey in Japan Ann. Surg. 2019 269 564 573 10.1097/SLA.0000000000002508
Abularrage C.J. Crawford R.S. Conrad M.F. Lee H. Kwolek C.J. Brewster D.C. Cambria R.P. LaMuraglia G.M. Preoperative Variables Predict Persistent Type 2 Endoleak after Endovascular Aneurysm Repair J. Vasc. Surg. 2010 52 19 24 10.1016/j.jvs.2010.02.023
Lederle F.A. Noorbaloochi S. Nugent S. Taylor B.C. Grill J.P. Kohler T.R. Cole L. Multicentre Study of Abdominal Aortic Aneurysm Measurement and Enlargement Br. J. Surg. 2015 102 1480 1487 10.1002/bjs.9895
Lalys F. Daoudal A. Gindre J. Göksu C. Lucas A. Kaladji A. Influencing Factors of Sac Shrinkage after Endovascular Aneurysm Repair J. Vasc. Surg. 2017 65 1830 1838 10.1016/j.jvs.2016.12.131
Chikazawa G. Hiraoka A. Totsugawa T. Tamura K. Ishida A. Sakaguchi T. Yoshitaka H. Influencing Factors for Abdominal Aortic Aneurysm Sac Shrinkage and Enlargement after EVAR: Clinical Reviews before Introduction of Preoperative Coil Embolization Ann. Vasc. Dis. 2014 7 280 285 10.3400/avd.oa.14-00050
Lo R.C. Bensley R.P. Hamdan A.D. Wyers M. Adams J.E. Schermerhorn M.L. Gender Differences in Abdominal Aortic Aneurysm Presentation, Repair, and Mortality in the Vascular Study Group of New England J. Vasc. Surg. 2013 57 1261 1268.e5 10.1016/j.jvs.2012.11.039
Greenhalgh R. Comparison of Endovascular Aneurysm Repair with Open Repair in Patients with Abdominal Aortic Aneurysm (EVAR Trial 1), 30-Day Operative Mortality Results: Randomised Controlled Trial Lancet 2004 364 843 848 10.1016/S0140-6736(04)16979-1
Prinssen M. Verhoeven E.L.G. Buth J. Cuypers P.W.M. van Sambeek M.R.H.M. Balm R. Buskens E. Grobbee D.E. Blankensteijn J.D. A Randomized Trial Comparing Conventional and Endovascular Repair of Abdominal Aortic Aneurysms N. Engl. J. Med. 2004 351 1607 1618 10.1056/NEJMoa042002
Laheij R.J.F. Buth J. Harris P.L. Moll F.L. Stelter W.J. Verhoeven E.L.G. Need for Secondary Interventions after Endovascular Repair of Abdominal Aortic Aneurysms. Intermediate-Term Follow-up Results of a European Collaborative Registry (EUROSTAR) Br. J. Surg. 2002 87 1666 1673 10.1046/j.1365-2168.2000.01661.x
Vallabhaneni S.R. Harris P.L. Lessons Learnt from the EUROSTAR Registry on Endovascular Repair of Abdominal Aortic Aneurysm Repair Eur. J. Radiol. 2001 39 34 41 10.1016/S0720-048X(01)00340-0
Thomas S.M. Beard J.D. Ireland M. Ayers S. Results from the Prospective Registry of Endovascular Treatment of Abdominal Aortic Aneurysms (RETA): Mid Term Results to Five Years Eur. J. Vasc. Endovasc. Surg. 2005 29 563 570 10.1016/j.ejvs.2005.03.012
Peppelenbosch N. Buth J. Harris P.L. van Marrewijk C. Fransen G. Diameter of Abdominal Aortic Aneurysm and Outcome of Endovascular Aneurysm Repair: Does Size Matter? A Report from EUROSTAR J. Vasc. Surg. 2004 39 288 297 10.1016/j.jvs.2003.09.047
Lederle F.A. The Strange Relationship between Diabetes and Abdominal Aortic Aneurysm Eur. J. Vasc. Endovasc. Surg. 2012 43 254 256 10.1016/j.ejvs.2011.12.026 22237512
Torsney E. Pirianov G. Cockerill G.W. Diabetes as a Negative Risk Factor for Abdominal Aortic Aneurysm—Does the Disease Aetiology or the Treatment Provide the Mechanism of Protection? CVP 2013 11 293 298 10.2174/1570161111311030003
Golledge J. Moxon J. Pinchbeck J. Anderson G. Rowbotham S. Jenkins J. Bourke M. Bourke B. Dear A. Buckenham T. et al. Association between Metformin Prescription and Growth Rates of Abdominal Aortic Aneurysms Br. J. Surg. 2017 104 1486 1493 10.1002/bjs.10587
Png C.Y.M. Tadros R.O. Kang M. Beckerman W.E. Tardiff M.L. Vouyouka A.G. Marin M.L. Faries P.L. The Protective Effects of Diabetes Mellitus on Post-EVAR AAA Growth and Reinterventions Ann. Vasc. Surg. 2017 43 65 72 10.1016/j.avsg.2016.10.059 28302476
Leurs L.J. Laheij R.J.F. Buth J. Influence of Diabetes Mellitus on the Endovascular Treatment of Abdominal Aortic Aneurysms J. Endovasc. Ther. 2005 12 288 296 10.1583/04-1260MR.1 15943503
Takahara M. Iida O. Tazaki J. Nishikawa R. Nanto K. Chiba Y. Sakamoto K. Kinoshita M. Takahashi N. Kamihira S. et al. Clinical Features and Prognosis of Patients with and without Diabetes Mellitus Undergoing Endovascular Aortic Aneurysm Repair BMC Endocr. Disord. 2022 22 92 10.1186/s12902-022-01008-4
Raffort J. Lareyre F. Fabre R. Mallat Z. Pradier C. Bailly L. Nationwide Study in France Investigating the Impact of Diabetes on Mortality in Patients Undergoing Abdominal Aortic Aneurysm Repair Sci. Rep. 2021 11 19395 10.1038/s41598-021-98893-x
Álvarez Marcos F. Llaneza Coto J.M. Camblor Santervás L.A. Zanabili Al-Sibbai A.A. Alonso Pérez M. Five Year Post-Endovascular Aneurysm Repair Aneurysm Sac Evolution in the GREAT Registry: An Insight in Diabetics Using Propensity Matched Controls Eur. J. Vasc. Endovasc. Surg. 2023 67 912 922 10.1016/j.ejvs.2023.10.033
Norman P.E. Davis T.M.E. Le M.T.Q. Golledge J. Matrix Biology of Abdominal Aortic Aneurysms in Diabetes: Mechanisms Underlying the Negative Association Connect. Tissue Res. 2007 48 125 131 10.1080/03008200701331524
Koole D. Van Herwaarden J.A. Schalkwijk C.G. Lafeber F.P.J.G. Vink A. Smeets M.B. Pasterkamp G. Moll F.L. A Potential Role for Glycated Cross-Links in Abdominal Aortic Aneurysm Disease J. Vasc. Surg. 2017 65 1493 1503.e3 10.1016/j.jvs.2016.04.028
De Vos L.C. Boersema J. Hillebrands J.L. Schalkwijk C.G. Meerwaldt R. Breek J.C. Smit A.J. Zeebregts C.J. Lefrandt J.D. Diverging Effects of Diabetes Mellitus in Patients with Peripheral Artery Disease and Abdominal Aortic Aneurysm and the Role of Advanced Glycation End-Products: ARTERY Study—Protocol for a Multicentre Cross-Sectional Study BMJ Open 2017 7 e012584 10.1136/bmjopen-2016-012584
Markovic J.N. Rajgor D.D. Shortell C.K. The Impact of Diabetes Mellitus and Renal Insufficiency on the Outcome of Endovascular Abdominal Aortic Aneurysm Repair Perspect. Vasc. Surg. Endovasc. Ther. 2010 22 235 244 10.1177/1531003511400427
Heath J.M. Sun Y. Yuan K. Bradley W.E. Litovsky S. Dell’Italia L.J. Chatham J.C. Wu H. Chen Y. Activation of AKT by O-Linked N-Acetylglucosamine Induces Vascular Calcification in Diabetes Mellitus Circ. Res. 2014 114 1094 1102 10.1161/CIRCRESAHA.114.302968
Jaiswal M. Schinske A. Pop-Busui R. Lipids and Lipid Management in Diabetes Best Pract. Res. Clin. Endocrinol. Metab. 2014 28 325 338 10.1016/j.beem.2013.12.001
Jacobs M.J. Kleisli T. Pio J.R. Malik S. L’Italien G.J. Chen R.S. Wong N.D. Prevalence and Control of Dyslipidemia among Persons with Diabetes in the United States Diabetes Res. Clin. Pract. 2005 70 263 269 10.1016/j.diabres.2005.03.032
Dangas G. O’Connor D. Firwana B. Brar S. Ellozy S. Vouyouka A. Arnold M. Kosmas C.E. Krishnan P. Wiley J. et al. Open Versus Endovascular Stent Graft Repair of Abdominal Aortic Aneurysms JACC Cardiovasc. Interv. 2012 5 1071 1080 10.1016/j.jcin.2012.06.015
Lo R.C. Buck D.B. Herrmann J. Hamdan A.D. Wyers M. Patel V.I. Fillinger M. Schermerhorn M.L. Risk Factors and Consequences of Persistent Type II Endoleaks J. Vasc. Surg. 2016 63 895 901 10.1016/j.jvs.2015.10.088
Pini R. Faggioli G. Mascoli C. Gallitto E. Freyrie A. Gargiulo M. Stella A. Influence of Statin Therapy on Type 2 Endoleak Evolution Ann. Vasc. Surg. 2015 29 1167 1173 10.1016/j.avsg.2015.03.036
Houbballah R. Majewski M. Becquemin J.-P. Significant Sac Retraction after Endovascular Aneurysm Repair Is a Robust Indicator of Durable Treatment Success J. Vasc. Surg. 2010 52 878 883 10.1016/j.jvs.2010.04.069
Monastiriotis S. Lau I. Loh S. Ferretti J. Tassiopoulos A. Labropoulos N. Evolution of Type II Endoleaks Based on Different Ultrasound-Identified Patterns J. Vasc. Surg. 2018 67 1074 1081 10.1016/j.jvs.2017.08.056
Pineda D.M. Calligaro K.D. Tyagi S. Troutman D.A. Dougherty M.J. Late Type II Endoleaks after Endovascular Aneurysm Repair Require Intervention More Frequently than Early Type II Endoleaks J. Vasc. Surg. 2018 67 449 452 10.1016/j.jvs.2017.05.124
Phan D.D.N. Meyer F. Pech M. Halloul Z. Length of Abdominal Aortic Aneurysm and Incidence of Endoleaks Type II after Endovascular Repair Wien. Klin. Wochenschr. 2015 127 851 857 10.1007/s00508-015-0871-y
Mulay S. Geraedts A.C.M. Koelemay M.J.W. Balm R. Mulay S. Balm R. Elshof J.W. Elsman B.H.P. Hamming J.F. Koelemay M.J.W. et al. Type 2 Endoleak With or Without Intervention and Survival After Endovascular Aneurysm Repair Eur. J. Vasc. Endovasc. Surg. 2021 61 779 786 10.1016/j.ejvs.2021.01.017
Geraedts A.C.M. Mulay S. Vahl A.C. Verhagen H.J.M. Wisselink W. de Mik S.M.L. van Dieren S. Koelemay M.J.W. Balm R. ODYSSEUS study group Editor’s Choice—Post-operative Surveillance and Long Term Outcome after Endovascular Aortic Aneurysm Repair in Patients with an Initial Post-operative Computed Tomography Angiogram Without Abnormalities: The Multicentre Retrospective ODYSSEUS Study Eur. J. Vasc. Endovasc. Surg. 2022 63 390 399 10.1016/j.ejvs.2021.11.018
Ward T.J. Cohen S. Fischman A.M. Kim E. Nowakowski F.S. Ellozy S.H. Faries P.L. Marin M.L. Lookstein R.A. Preoperative Inferior Mesenteric Artery Embolization before Endovascular Aneurysm Repair: Decreased Incidence of Type II Endoleak and Aneurysm Sac Enlargement with 24-Month Follow-Up J. Vasc. Interv. Radiol. 2013 24 49 55 10.1016/j.jvir.2012.09.022
Sakalihasan N. Bruls S. Hustinx R. Tchana-Sato V. Sakalihasan S. Hultgren R. Labropoulos N. Colige A. Durieux R. Drion P. et al. Association between PET/CT Scan Findings, Treatment, and Cancer Incidence in a Cohort of AAA Patients J. Clin. Med. 2024 13 1569 10.3390/jcm13061569
