Impact of type 2 diabetes on postoperative outcomes after endovascular aortic aneurysm repair – a cohort study
INTRODUCTION: Although the incidence of abdominal aortic aneurysms (AAA) has declined over the last two decades, this condition has high mortality rates when symptomatic or ruptured. Paradoxically, diabetes seems to slow AAA progression or rupture. However, there is little and contradictory data re...
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Sociedade Portuguesa de Angiologia e Cirurgia Vascular
2025-04-01
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| Series: | Angiologia e Cirurgia Vascular |
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| Online Access: | https://acvjournal.com/index.php/acv/article/view/617 |
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| author | António Duarte Hugo Fabian Gonçalves Ryan Gouveia e Melo Pedro Amorim Ruy Fernandes e Fernandes Luís Mendes Pedro |
| author_facet | António Duarte Hugo Fabian Gonçalves Ryan Gouveia e Melo Pedro Amorim Ruy Fernandes e Fernandes Luís Mendes Pedro |
| author_sort | António Duarte |
| collection | DOAJ |
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INTRODUCTION: Although the incidence of abdominal aortic aneurysms (AAA) has declined over the last two decades, this condition has high mortality rates when symptomatic or ruptured. Paradoxically, diabetes seems to slow AAA progression or rupture. However, there is little and contradictory data regarding the postoperative setting. This study aims to evaluate the clinical impact of diabetes after standard EVAR.
MATERIALS AND METHODS: We performed a retrospective cohort study with consecutively enrolled patients who underwent EVAR at a tertiary center between January 2013 and April 2022. Patients were categorized according to the presence of type 2 diabetes. The primary outcome was the incidence rate of aortic events (aortic reinterventions, rupture, and mortality). Secondary outcomes comprised overall mortality, endoleak rate and sac diameter variation during follow-up. Pearson’s Chi-squared test was performed for descriptive analysis. Survival and multivariable analyses were performed through Cox proportional regression models.
RESULTS: A total of 381 patients comprised this cohort, with 82 (21%, 95% CI 17.5-26) identified as diabetic. The average follow-up duration was 27±24 months. Diabetic patients showed a higher prevalence of dyslipidemia (91.4% vs. 74.3%, p<0.001) and hypertension (95.1% vs. 85.1%, p =0.016). Most patients were treated with oral antidiabetics (86.6%), primarily metformin (62.1%). Additionally, 9% of diabetics received insulin therapy. A non-significant trend indicated that diabetic patients experienced a higher incidence of aortic events, particularly after 12 months (adjusted hazard ratio [aHR]: 1.39, 95% confidence interval [CI] 0.71-2.73). Notably, mortality rates were significantly higher among diabetic patients (aHR: 1.86; p=0.02). However, diabetes did not affect sac shrinkage or endoleak rate.
CONCLUSION: While diabetes seems to slow AAA progression, this condition appears to have a negative influence after EVAR, with a higher rate of aortic events and overall mortality. Further studies should explore the interplay between these conditions.
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| format | Article |
| id | doaj-art-cce730e8a06442c8a4e01f959a8dfe88 |
| institution | OA Journals |
| issn | 1646-706X 2183-0096 |
| language | Portuguese |
| publishDate | 2025-04-01 |
| publisher | Sociedade Portuguesa de Angiologia e Cirurgia Vascular |
| record_format | Article |
| series | Angiologia e Cirurgia Vascular |
| spelling | doaj-art-cce730e8a06442c8a4e01f959a8dfe882025-08-20T02:15:41ZporSociedade Portuguesa de Angiologia e Cirurgia VascularAngiologia e Cirurgia Vascular1646-706X2183-00962025-04-0120410.48750/acv.617Impact of type 2 diabetes on postoperative outcomes after endovascular aortic aneurysm repair – a cohort studyAntónio Duarte0Hugo Fabian Gonçalves1Ryan Gouveia e Melo2Pedro Amorim3Ruy Fernandes e Fernandes4Luís Mendes Pedro5Division of Vascular Surgery, Heart and Vessels Department, Unidade Local de Saúde Santa Maria, Lisbon, Portugal; CCUL@RISE, University of Lisbon, PortugalFaculty of Medicine, University of Lisbon, Lisbon, PortugalDivision of Vascular Surgery, Heart and Vessels Department, Unidade Local de Saúde Santa Maria, Lisbon, Portugal; Faculty of Medicine, University of Lisbon, Lisbon, Portugal; CCUL@RISE, University of Lisbon, Portugal; Lisbon Academic Medical Centre, Lisbon, PortugalDivision of Vascular Surgery, Heart and Vessels Department, Unidade Local de Saúde Santa Maria, Lisbon, Portugal; Faculty of Medicine, University of Lisbon, Lisbon, Portugal; Lisbon Academic Medical Centre, Lisbon, PortugalDivision of Vascular Surgery, Heart and Vessels Department, Unidade Local de Saúde Santa Maria, Lisbon, Portugal; Faculty of Medicine, University of Lisbon, Lisbon, Portugal; CCUL@RISE, University of Lisbon, Portugal; Lisbon Academic Medical Centre, Lisbon, PortugalDivision of Vascular Surgery, Heart and Vessels Department, Unidade Local de Saúde Santa Maria, Lisbon, Portugal; Faculty of Medicine, University of Lisbon, Lisbon, Portugal; CCUL@RISE, University of Lisbon, Portugal; Lisbon Academic Medical Centre, Lisbon, Portugal INTRODUCTION: Although the incidence of abdominal aortic aneurysms (AAA) has declined over the last two decades, this condition has high mortality rates when symptomatic or ruptured. Paradoxically, diabetes seems to slow AAA progression or rupture. However, there is little and contradictory data regarding the postoperative setting. This study aims to evaluate the clinical impact of diabetes after standard EVAR. MATERIALS AND METHODS: We performed a retrospective cohort study with consecutively enrolled patients who underwent EVAR at a tertiary center between January 2013 and April 2022. Patients were categorized according to the presence of type 2 diabetes. The primary outcome was the incidence rate of aortic events (aortic reinterventions, rupture, and mortality). Secondary outcomes comprised overall mortality, endoleak rate and sac diameter variation during follow-up. Pearson’s Chi-squared test was performed for descriptive analysis. Survival and multivariable analyses were performed through Cox proportional regression models. RESULTS: A total of 381 patients comprised this cohort, with 82 (21%, 95% CI 17.5-26) identified as diabetic. The average follow-up duration was 27±24 months. Diabetic patients showed a higher prevalence of dyslipidemia (91.4% vs. 74.3%, p<0.001) and hypertension (95.1% vs. 85.1%, p =0.016). Most patients were treated with oral antidiabetics (86.6%), primarily metformin (62.1%). Additionally, 9% of diabetics received insulin therapy. A non-significant trend indicated that diabetic patients experienced a higher incidence of aortic events, particularly after 12 months (adjusted hazard ratio [aHR]: 1.39, 95% confidence interval [CI] 0.71-2.73). Notably, mortality rates were significantly higher among diabetic patients (aHR: 1.86; p=0.02). However, diabetes did not affect sac shrinkage or endoleak rate. CONCLUSION: While diabetes seems to slow AAA progression, this condition appears to have a negative influence after EVAR, with a higher rate of aortic events and overall mortality. Further studies should explore the interplay between these conditions. https://acvjournal.com/index.php/acv/article/view/617Abdominal aortic aneurysm post-operative complicationsdiabetes mellitusanti-diabetic drugs |
| spellingShingle | António Duarte Hugo Fabian Gonçalves Ryan Gouveia e Melo Pedro Amorim Ruy Fernandes e Fernandes Luís Mendes Pedro Impact of type 2 diabetes on postoperative outcomes after endovascular aortic aneurysm repair – a cohort study Angiologia e Cirurgia Vascular Abdominal aortic aneurysm post-operative complications diabetes mellitus anti-diabetic drugs |
| title | Impact of type 2 diabetes on postoperative outcomes after endovascular aortic aneurysm repair – a cohort study |
| title_full | Impact of type 2 diabetes on postoperative outcomes after endovascular aortic aneurysm repair – a cohort study |
| title_fullStr | Impact of type 2 diabetes on postoperative outcomes after endovascular aortic aneurysm repair – a cohort study |
| title_full_unstemmed | Impact of type 2 diabetes on postoperative outcomes after endovascular aortic aneurysm repair – a cohort study |
| title_short | Impact of type 2 diabetes on postoperative outcomes after endovascular aortic aneurysm repair – a cohort study |
| title_sort | impact of type 2 diabetes on postoperative outcomes after endovascular aortic aneurysm repair a cohort study |
| topic | Abdominal aortic aneurysm post-operative complications diabetes mellitus anti-diabetic drugs |
| url | https://acvjournal.com/index.php/acv/article/view/617 |
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