C-reactive protein predicts aortic aneurysmal disease progression after endovascular repair. (1st January 2016)

• Record Type: Journal Article
• Authors: De Haro, Joaquin; Bleda, Silvia; Acin, Francisco
• Is Part Of: International journal of cardiology. Volume 202(2016)
• Page Start: 701
• Page End: 706
• Publication Date: 2016-01-01
• Subjects: Abdominal aorta aneurysm -- EVAR -- C-reactive protein -- Endovascular -- Inflammation -- Aneurysm disease; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2015.09.122
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Objectives: This study aims to investigate the prognostic significance of the rate of variation of C-reactive protein (CRP) levels as a predictor of aneurysmal sac and neck expansion and, therefore, of aneurysm disease progression, in patients undergoing endovascular aneurysm repair (EVAR) in the absence of endoleaks. Methods: 192 patients following non-emergency elective EVAR for asymptomatic infra-renal abdominal aorta aneurysm (AAA) were included after a six-month period after intervention to ensure the treatment success and absence of endoleaks. Expansion of aneurysm sac or neck after the six-month stabilization term occurred in 120 (63%) and 128 (67%) patients for a mean follow-up of 53 ± 23 months. Results: The relative CRP plasma level gradient significantly differed between the subgroups of patients according to relative sac expansion quartiles (7%, 26%, 39%, and 61%; p < 0.001). In the bivariate analysis, the aorta sac diameter expansion rate progressively increased in the subgroups determined by CRP gradient quartiles (− 0.5 ± 1%, 3.6 ± 1%, 8 ± 2%, 10 ± 3%; p < 0.01). The median (25th; 75th quartile) CRP level rise in "rapid expanders" patients (those above the median annual sac expansion rate of 5.7%) was 51% (37%; 67%) compared with 15% (3%; 28%) in "slow- or non-expanders" (p < 0.001). The multivariate age-adjusted logistic model confirmed the variation of CRP level and neck length as the only factors independently associated to sac expansion (odds ratio 4.3; 95% CI: 2.3–7.9 and 1.7; 95% CI: 1.3–2.2, respectively). Conclusion: There is a significant time-related association between AAA sac diameter enlargement and CRP plasma level gradient after EVAR in the absence of endoleaks, confirming the latter as a proper marker of aneurysm disease progression and rate of expansion in these patients. Highlights: First-ever reported study on inflammatory cause of aneurysm expansion after EVAR Time-related association between CRP variation and aneurysm sac growth after EVAR Sac enlargement is associated to CRP gradient after EVAR, in the absence of endoleaks. CRP may be used as a marker of aneurysm disease progression and rate of expansion.