Impact of osteoporosis on survival and aneurysm remodeling after endovascular aortic repair

Abstract

Background:

Osteoporosis has been suggested to be associated with abdominal aortic aneurysms, yet its impact on endovascular aneurysm repair (EVAR) outcomes remains unclear. This study evaluated the impact of osteoporosis on long-term outcomes and aneurysm sac remodeling in patients undergoing EVAR.

Methods:

This single-center retrospective study included 119 patients who underwent EVAR between 2014 and 2018. Osteoporosis was defined as morphological vertebral compression fractures or an L1 vertebral trabecular attenuation (⩽ 110 Hounsfield units [HU]) on preoperative computed tomography. Patients were stratified into osteoporosis (O; n = 74) and nonosteoporosis (NO; n = 45) groups to compare clinical outcomes and aneurysm sac behavior. Multivariable analyses were performed to identify predictors of mortality and sac changes.

Results:

The O group had a significantly higher all-cause mortality (39.2% vs 18.1%, p = 0.012) and lower 10-year survival (40.8% vs 79.5%, p < 0.05). Sac shrinkage was more frequent in the NO group (1.6 ± 8.6 vs −7.6 ± 10.3 mm, p < 0.001). Lower L1 HU was significantly associated with sac expansion. Pharmacologic treatment yielded greater sac reduction than nontreatment (−4.3 ± 2.6 vs 2.6 ± 1.0 mm, p = 0.015). Multivariable analysis identified osteoporosis, older age, and type II endoleaks as independent predictors of sac enlargement, whereas osteoporosis treatment was independently associated with sac shrinkage.

Conclusions:

Osteoporosis is associated with reduced survival and impaired aneurysm sac remodeling following EVAR. Pharmacological treatment may promote sac remodeling and improve clinical outcomes. Routine evaluation and management of osteoporosis may be important post-EVAR care strategies.