Prognostic Utility of Perivascular Adipose Tissue Attenuation in Patients Undergoing Endovascular Aneurysm Repair for Abdominal Aortic Aneurysms.

BACKGROUND

Perivascular adipose tissue (PVAT) attenuation on computed tomography angiography reflects vascular inflammation. However, its prognostic value in patients undergoing endovascular aortic repair (EVAR) for abdominal aortic aneurysm (AAA) remains unclear.

METHODS

We retrospectively studied consecutive patients who underwent EVAR for unruptured infrarenal AAA with preprocedural computed tomography angiography. PVAT attenuation and aortic characteristics were assessed using computed tomography angiography. The primary outcome was major adverse cardiac or cerebrovascular events (MACCE), a composite of all-cause death, myocardial infarction, stroke, and any vessel treatment.

RESULTS

Among 275 patients treated with EVAR, 35.6% (98/275) experienced MACCE during a median follow-up of 3.5 years. Pre-EVAR PVAT attenuation was higher in patients who experienced MACCE than in those who did not (-69.8±10.3 HU versus -77.3±8.6 HU; P<0.001). In the Cox proportional hazards model, higher PVAT attenuation (per 10 HU; unadjusted hazard ratio, 1.88 [95% CI, 1.56-2.28]; P<0.001) was associated with MACCE after EVAR. Furthermore, higher PVAT attenuation was associated with AAA-related adverse events: a composite of AAA-related death, reintervention for AAA, embolization for endoleak, and AAA enlargement (per 10 HU; unadjusted hazard ratio, 2.16 [95% CI, 1.59-2.94]). Adding PVAT attenuation to post-EVAR prognostic factors and computed tomography angiography findings improved the predictive and reclassification abilities for MACCE after EVAR.

CONCLUSIONS

In patients undergoing EVAR, higher PVAT attenuation was associated with both MACCE and AAA-related adverse events. PVAT attenuation may provide incremental prognostic value for identifying patients at higher risk of unfavorable outcomes following EVAR.