Estimating the influence of aortic-stent grafts after endovascular aneurysm repair: Are we missing something?

The implantation of a stiff aortic endograft for endovascular abdominal aneurysm repair (EVAR) has been reported to increase aortic stiffness and pulse wave velocity (PWV), raising potential concern over deterioration of myocardial performance. Yet, additional stiffness indices such as the augmentation index (AIx), reflection magnitude (RM) and changes in augmentation pressure (AP) have not been studied adequately to facilitate and improve our knowledge regarding the ways that EVAR affects central hemodynamics. In this article it is suggested that the implantation of an aortic stent-graft exerts its immediate effects not only by interposing extra stiffness on the infrarenal segment but by also modifying the pulse wave reflection site and changing the aortic flow field without necessarily causing significant alterations in PWV. Hence, further studies on myocardial performance in large patient populations are expected to delineate the precise influence of different designs of EVAR endografts on the cardiovascular hemodynamic which, in turn, can affect the morbidity and survival of these patients.