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Validation of Central Pressure Estimation in Patients with an Aortic Aneurysm Before and After Endovascular Repair

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Abstract

Purpose

The aim of this study was to investigate if non-invasive central pressure estimations are accurate in patients with an abdominal aortic aneurysm, before and after endovascular repair. Secondary evaluation was if measurement-accuracy was dependent on anatomical characteristics.

Methods

Procedural invasive and non-invasive pressure-measurements were performed simultaneously both before and after endovascular repair in 20 patients with an infrarenal abdominal aortic aneurysm. Invasive catheter measurements were performed in the abdominal aorta. A tonometric device was used to perform non-invasive pressure–wave-analysis at the radial artery. A generalized transfer-function was used to generate an ascending aortic waveform for both measurements, allowing for direct comparison.

Results

Pre-treatment the mean differences between methods were − 5.5 mmHg (p = .904), − 11.8 (p < .001), and − 7.2 mmHg (p = .124) for central systolic, diastolic, and mean pressure, respectively. The accuracy was dependent of aneurysm sac volume and intraluminal thrombus volume. Post-treatment limits of agreement were smaller for all pressure parameters compared to pre-treatment. The mean differences were 6.5 mmHg (p = .007), − 6.4 (p < .020), and 1.6 mmHg (p = .370) for central systolic, diastolic, and mean pressure, respectively.

Conclusion

In untreated AAA’s the accuracy of non-invasive central pressure estimation was acceptable (mean difference between 5 and 10 mmHg) when compared to invasive pressures, but dependent of AAA characteristics. After EVAR the accuracy of central pressure estimation improved (reduction of 75% of the mean difference between pre and post measurements)

Trial Registration Number

NCT03469388; 3-5-2018.

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Abbreviations

AAA:

Abdominal aortic aneurysm

Aix:

Augmentation index

AIx@HR75:

Augmentation index corrected for a heart rate of 75 beats per minute

ARX:

Autoregressive exogenous

CT:

Computed tomography

EVAR:

Endovascular aneurysm repair

IQR:

Interquartile range

SEVR:

Subendocardial viability ratio

TF:

Transfer function

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Acknowledgments

We greatly acknowledge the valuable contribution of Berend Westerhof, Diantha Schipaanboord, Lisa Rutten, Thomas Urgert, and Gerike Buitenhuis. The funding provided by the “Vriendenfonds Rijnstate” is greatly acknowledged.

Funding

This is an investigator-initiated study without funding by industry. Financial support was obtained by the Rijnstate “Vriendenfonds”. This fund did not have any involvement in the research.

Data Availability

Data will be available on request.

Code availability

Code is provided in the supplemental material and others will be provided on request.

Conflict of interest

The authors have no conflicts of interests.

Ethics Approval

The study was approved by the regional Medical Ethics Committee (CMO-2016-2431) and the local Institutional Review Board.

Informed Consent

The study was conducted in accordance with the principles of the Declaration of Helsinki and Good Clinical Practice guidelines. Patients with an infrarenal AAA scheduled for EVAR and aged ≥18 years were approached and included after providing written informed consent. All authors have approved the final version of the manuscript for publication.

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Authors and Affiliations

  1. Vascular Center, Department of Surgery, Rijnstate, P.O. Box 9555, 6800 TA, Arnhem, The Netherlands

    S. Holewijn, J. J. M. Vermeulen, M. van Helvert, L. van de Velde & M. M. P. J. Reijnen

  2. MultiModality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, The Netherlands

    M. van Helvert, L. van de Velde & M. M. P. J. Reijnen

  3. Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands

    J. J. M. Vermeulen

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  1. S. Holewijn
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Correspondence to S. Holewijn.

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Associate Editor Ajit P. Yoganathan oversaw the review of this article.

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Holewijn, S., Vermeulen, J.J.M., van Helvert, M. et al. Validation of Central Pressure Estimation in Patients with an Aortic Aneurysm Before and After Endovascular Repair. Cardiovasc Eng Tech 13, 265–278 (2022). https://doi.org/10.1007/s13239-021-00574-3

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