Vaskulárna medicína 1/2019

Higher preprocedural fibrinogen levels are associated with sac regression after endovacular abdominal aneurysm repair

Background: Abdominal aortic aneurysm (AAA) is a polygenic disease with unknown ethiology and poorly defined pathology. The aim of our study was to determine an association of polymorphism related to AAA, preprocedural fibrinogen levels with aneurysm sac regression after endovascular abdominal aortic aneurysm repair. Methods: We retrospectively analyzed data of patients with infrarenal AAA treated between January, 2010 and July, 2016. Sac regression was defined as at least 5 mm decrease in the sac diameter in relation to the preprocedural diameter. Sac diameter pre– and 24 months post–EVAR was determined by CT– angiography at the site of maximum axial diameter. The selection of gene polymorphisms (gene LRP1, IL6R , MMP3, AGTR1, 9p21) was based on results of the meta–analysis which showed that the mentioned variants were associated with AAA. Preprocedural fibrinogen was measured using the Clauss method. Results: During the study period, 124 patients (116 men and 8 women) with mean age 71.2 ± 7.2 years met inclusion criteria. Sac regression was found in 45.2% of patients. Higher fibrinogen levels were found in patients with sac regression in comparison with the patients with stable sac or sac expansion (3.84 g/l vs 3.47 g/l; p=0,028). A higher fibrinogen was a significant predictor of sac regression in multivariate analysis after adjustment for age, hypertension, sex, smoking and dyslipidaemia (OR 1.88; 95%CI 1.17–3.04; p=0.010); i.e increase of fibrinogen by 1g/l increased probability of sac regression by 88%. Additional adjustments for ILT volume and percentage of ILT occupying aortic lumen increased the OR to 2.47 (95% CI 1.29–4.72; p=0.006). The association between genotypes/alleles distribution of selected single nucleotide polymorphism (LRP1 rs1466535, MMP3 rs3025058, IL6R rs7529229, AGTR1 rs5186, 9p21 rs10757278) and sac regression was not confirmed in univariate and multivariate analysis. Conclusion: Higher preprocedural fibrinogen levels were predictive factors of aneurysm sac regression patients post–EVAR.

Keywords: endovascular abdominal aortic aneurysm repair, fibrinogen, abdominal aortic aneurysm, gene polymorphism, sac regression