Association Between Aneurysm Wall Inflammation Detected by Imaging Perivascular Fat and Secondary Intervention Risk for Abdominal Aortic Aneurysm Patients After Endovascular Repair

Abstract

Objective:

To investigate the association between the imaging biomarker (volumetric perivascular characterization index [VPCI]) which indicates the aortic wall inflammation by mapping the spatial changes of perivascular fat attenuation on computed tomography angiography (CTA) and the reintervention risk for abdominal aortic aneurysm (AAA) patients after endovascular aortic repair (EVAR).

Methods:

This case-control study included AAA patients undergoing EVAR from a single center (n=260). Cases were AAA patients undergoing reintervention after EVAR and a 1:1 frequency-matched control group of AAA patients post-EVAR with a shrunken or ≥3-year stable sac and free of reintervention signs during the follow-up. The predictive variable (VPCI trajectory) was converted to binary variables according to the changing trend of VPCI with follow-up time. As a quasi-complete separation data pattern, least absolute shrinkage and selection operator (lasso) regression was used to screen and prove the VPCI trajectory as the best predictor, and the performance was evaluated by calculating the accuracy, sensitivity, and specificity.

Results:

Between 2010 and 2021, 15 AAA patients after EVAR with type I/III endoleak, aneurysm rupture, or impending rupture were included. Compared with the 1:1 frequency-matched controls with a shrunken or ≥3-year stable sac and free of reintervention signs during the follow-up, VPCI trajectories of the case group were all upward trends, whereas the controls showed 86.7% downward trends (p<0.001). The best predictive model of lasso regressions included 4 variables, and VPCI trajectory was the most outstanding, followed by the proximal landing zone, the distal landing zone, and the infrarenal β angle. The accuracy, sensitivity, and specificity of predicting the risk of reintervention were as follows, respectively: 93.3%, 100%, and 86.7%.

Conclusions:

The wall inflammation detected by imaging perivascular adipose tissue based on the CTAs was strongly associated with the reintervention risk for AAA patients after EVAR, which might hold major promise as a new imaging biomarker for the mechanism and treatment study of human AAAs before and after EVAR.

Clinical Impact

The study introduces a novel imaging biomarker which indicates the aortic wall inflammation by mapping spatial changes of perivascular fat attenuation on CTA. This biomarker demonstrates a strong association with the reintervention risk in AAA patients after EVAR. Incorporation of VPCI into clinical practice has the potential to enhance the traditional surveillance methods (CT/CTAs) by providing clinicians with a non-invasive method to assess aortic wall inflammation and predict the risk of reintervention. Additionally, this study might offer a valuable tool for mechanism and treatment research in humans with AAAs both pre- and post-EVAR, ultimately improving patient outcomes and refining therapeutic strategies.

Keywords

abdominal aortic aneurysm perivascular adipose tissue fat attenuation index volumetric perivascular characterization index endovascular aortic repair

Get full access to this article

View all access options for this article.

References

Qiu

Wang

Zhao

, et al. Association between blood flow pattern and rupture risk of abdominal aortic aneurysm based on computational fluid dynamics. Eur J Vasc Endovasc Surg. 2022;64(2-3):155–164. doi:10.1016/j.ejvs.2022.05.027.

Speelman

Schurink

Bosboom

, et al. The mechanical role of thrombus on the growth rate of an abdominal aortic aneurysm. J Vasc Surg. 2010;51(1):19–26. doi:10.1016/j.jvs.2009.08.075.

Antonopoulos

Sanna

Sabharwal

, et al. Detecting human coronary inflammation by imaging perivascular fat. Sci Transl Med. 2017;9(398):eaal2658. doi:10.1126/scitranslmed.aal2658.

Oikonomou

Marwan

Desai

, et al. Non-invasive detection of coronary inflammation using computed tomography and prediction of residual cardiovascular risk (the CRISP CT study): a post-hoc analysis of prospective outcome data. Lancet (London, England). 2018;392(10151):929–939. doi:10.1016/s0140-6736(18)31114-0.

Dias-Neto

Meekel

van Schaik

, et al. High density of periaortic adipose tissue in abdominal aortic aneurysm. Eur J Vasc Endovasc Surg. 2018;56(5):663–671. doi:10.1016/j.ejvs.2018.07.008.

Yamaguchi

Yonetsu

Hoshino

, et al. Clinical significance of increased computed tomography attenuation of periaortic adipose tissue in patients with abdominal aortic aneurysms. Cir J. 2021;85(12):2172–2180. doi:10.1253/circj.CJ-20-1014.

Schwartz

Taljanovic

Smyth

, et al. CT findings of rupture, impending rupture, and contained rupture of abdominal aortic aneurysms. AJR Am J Roentgenol. 2007;188(1):W57–W62. doi:10.2214/ajr.05.1554.

Schanzer

Greenberg

Hevelone

, et al. Predictors of abdominal aortic aneurysm sac enlargement after endovascular repair. Circulation. 2011;123(24):2848–2855. doi:10.1161/circulationaha.110.014902.

Taudorf

Jensen

Vogt

, et al. Endograft limb occlusion in EVAR: iliac tortuosity quantified by three different indices on the basis of preoperative CTA. Eur J Vasc Endovasc Surg. 2014;48(5):527–533. doi:10.1016/j.ejvs.2014.04.018.

10.

Fenelli

Gargiulo

Prendes

, et al. Effect of iliac tortuosity on outcomes after iliac branch procedures. J Vasc Surg. 2022;76(3):714–723. doi:10.1016/j.jvs.2022.01.142.

11.

Jalalzadeh

Indrakusuma

Planken

, et al. Inflammation as a predictor of abdominal aortic aneurysm growth and rupture: a systematic review of imaging biomarkers. Eur J Vasc Endovasc Surg. 2016;52(3):333–342. doi:10.1016/j.ejvs.2016.05.002.

12.

MA3RS Study Investigators. Aortic wall inflammation predicts abdominal aortic aneurysm expansion, rupture, and need for surgical repair. Circulation. 2017;136(9):787–797. doi:10.1161/circulationaha.117.028433.

13.

Mamopoulos

Freyhardt

Touloumtzidis

, et al. Quantification of periaortic adipose tissue in contrast-enhanced CT angiography: technical feasibility and methodological considerations [published online ahead of print February 26, 2022]. Int J Cardiovasc Imag. doi:10.1007/s10554-022-02561-8.