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Published on: January 27, 2023
Low Iliofemoral Calcium Score May Predict Higher Survival after EVAR and FEVAR
Roberta Vaccarino1, Mohammed Abdulrasak1, Timothy Resch1
1Department of Thoracic and Vascular Surgery, Vascular Center, Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
Insights
A low iliofemoral calcium score may indicate better long-term survival after endovascular aortic repair (EVAR) and fenestrated endovascular aortic repair (FEVAR). This finding suggests a potential link between calcification and reduced cardiac events and mortality.
Area of Science:
- Vascular Surgery
- Cardiology
- Radiology
Background:
- Abdominal aortic aneurysm repair carries significant mortality risks, primarily from cardiovascular events.
- Aortoiliac calcification is linked to increased mortality in peripheral occlusive disease patients.
Purpose of the Study:
- To investigate the association between iliofemoral calcification, measured by calcium score, and long-term mortality after EVAR and FEVAR.
- To determine if iliofemoral calcification predicts cardiac events post-procedure.
Main Methods:
- Retrospective analysis of 651 patients undergoing EVAR/FEVAR for nonruptured abdominal aortic aneurysms (2004-2012).
- Preoperative noncontrast CT scans were used to calculate the Agatston calcium score from the aortic bifurcation to common femoral arteries.
- 404 patients had sufficient imaging quality for inclusion.
Main Results:
- Patients in the lowest quartile of iliofemoral calcium score demonstrated significantly higher overall survival at 5 years (79% vs. 71%).
- Lower calcium scores were also associated with significantly higher cardiac event-free survival at 5 years (95% vs. 91%).
- Calcium score did not show a significant association in univariate regression analysis for overall survival or cardiac event-free survival.
Conclusions:
- A low iliofemoral calcium score may correlate with reduced long-term all-cause mortality and fewer fatal cardiac events following EVAR and FEVAR.
- This association might reflect underlying aging and cardiovascular comorbidities, warranting further investigation.
Background:
Abdominal aortic aneurysm is associated with an increased mortality, mostly cardiovascular events. Moreover, aortoiliac calcification is associated with increased mortality in patients with peripheral occlusive disease. The aim of this study is to assess the potential association between iliofemoral calcification, assessed by calcium score, in patients undergoing infrarenal (endovascular aneurysm repair [EVAR]) or fenestrated endovascular aortic repair (FEVAR) and long-term mortality, particularly caused by cardiac events.
Methods:
All patients with preoperative noncontrast-enhanced computed tomographic scans who underwent infrarenal EVAR and FEVAR of nonruptured abdominal aortic aneurysm between 2004 and 2012 at a single tertiary center were screened for inclusion. Agatston calcium score was measured from the aortic bifurcation to common femoral arteries using a dedicated postprocessing software. The values are presented as median and interquartile range.
Results:
About 404 (62.05%) of 651 patients who underwent EVAR and FEVAR had sufficient imaging quality to be included. There was no difference in survival between included and excluded patients (P = 0.33). Nine patients (2.2%) died within 30 days of the operation, whereas the remaining were followed up for 6.3 (4.7-8.4) years. The iliofemoral calcium score was 8348 (3830-14,179). Estimated overall survival at 5 years was 73 ± 2%. Patients within the lowest quartile of iliofemoral calcium score had significantly higher overall survival (5 years: 79 ± 4% vs. 71 ± 3%; P = 0.01) and cardiac event-free survival (5 years: 95 ± 2% vs. 91 ± 2%; P = 0.033) when compared with the remaining ones. Calcium score was associated with neither univariate regression analysis with survival (odds ratio, 1.016 [0.988-1.045]; P = 0.268) nor cardiac event-free survival (odds ratio, 1.024 [0.986-1.063]; P = 0.222).
Conclusions:
Low iliofemoral calcium score may be associated with lower incidence of fatal cardiac events and all-cause long-term mortality after EVAR and FEVAR. This may be partially a reflection of aging and cardiovascular comorbidity but needs to be studied further.
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