Abdominal Aortic Aneurysm Clinical Trial
The present study will investigate the effect of artificially stiffening the aorta by means of an aortic stent on central aortic haemodynamics (CAH). This study will determine whether aortic stenting inadvertently adversely impacts on CAH, thereby providing the rational for subsequent therapeutic intervention to reduce the associated cardiovascular risk.
Increased pulse pressure and pulse-wave velocity are recognized indices of arterial stiffness
(Laurent, Boutouyrie, Asmar et al., 2001; Qiu, Winblad, Viitanen et al., 2003). An increased
pulse pressure (indicative of increased central aortic pressure) is independently associated
with an increased incidence of postoperative neurological and cardiac complications (Fontes,
Aronson, Matthew et al., 2008). Pulse pressure has been identified as an independent
predictor of cerebrovascular events after cardiac surgery (Benjo, Thompson, Fine et al.,
2007). Moreover, many studies have demonstrated that pulse-wave velocity is an independent
predictor of morbidity and mortality in a range of study populations (for a review see
Vlachopoulos, Aznaouridis, Stefanadis, 2010). An increasing body of evidence suggests that
brachial artery pressure, although representative, is not an accurate reflection of central
aortic pressure. The Conduit Artery Function Evaluation study, for example, revealed that
certain drugs preferentially reduce central aortic pressure, whilst having similar effects on
brachial artery pressure. Moreover, in this study central aortic pulse pressure was
demonstrated to be an independent predictor of clinical outcomes (Williams, Lacy, Thom et
al., 2006). Other studies support the finding that markers of CAP are more closely related to
surrogate measures of cardiovascular risk such as left ventricular mass (Haider, Larson,
Franklin et al., 2003) and carotid intima-media thickness (Kostis, Davis, Cutler et al.,
1997).
One inadvertent effect of stenting is the introduction of a semi rigid conduit into the
circulation. This could potentially increase pulse wave velocity and adversely affect central
aortic pressures and haemodynamics. The investigators thus aim to investigate the effect of
aortic aneurysm of surgery on central aortic pressures and haemodynamics
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