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Effect of Graft Fabric on Pulse Wave Velocity following Endovascular Aneurysm Repair

In the current issue of the JEVT, Kadoglou el al. continue to report their work on the effect of endovascular aneurysm repair (EVAR) on pulse wave velocity (PWV), which is a valid representative of arterial wall stiffness. While their earlier work identified the augmentation of PWV following EVAR, in this study, they also have found a novel effect of the fabric covering the stent-grafts. They observed a significant increase in PWV and inflammatory markers in response to grafts covered with polyester and polytetrafluoroethylene, though the increase was more pronounced in the former group. This is a very interesting finding that could shape clinical practice if the observations can be correlated to clinical outcome. Having said that, it is not entirely clear whether this significant difference between the graft fabrics in the increase in PWV is solely due to fabric effect or perhaps to the skeleton of the graft. Most of the graft skeletons were nitinol with only one group formed of a mix of nitinol and stainless steel. You would expect the graft skeleton to exert more effect on the stiffness of the aortic wall than the graft fabric. It will be very interesting to know if there is a difference in PWV in relation to the graft skeleton. PWV reflects arterial wall stiffness and is significantly associated with cardiovascular morbidity and mortality. Several studies have reported increased PWV in patients with abdominal aortic aneurysm in comparison to the control group with the exception of Lee et al. However, very little if anything is known about the correlation between the increase in PWV following EVAR and the clinical cardiovascular outcome in this group of patients. There has been a growing concern about the loss of the early postoperative benefit of EVAR on all-cause mortality at the long term. If the graft fabric and arterial stiffness could be correlated to the long-term cardiovascular outcome in this group of patients, that would provide an explanation for the increased longterm mortality of patients undergoing EVAR in comparison to open aneurysm repair. Unfortunately, none of the researchers in the current report or previous studies have provided any findings concerning this issue. Furthermore, more information is required concerning the trend of the PWV increment after EVAR. In the current study, Kadoglou et al. present the increase at 12 months post EVAR, having previously reported the increase at 6 months. However, nothing is known about whether the trend is rising or declining. This is another area that needs to be explored to identify the clinical importance of the finding in the current study. There are two more areas of possible future studies that I would suggest. First, the difference in PWV between different types of