Impact of type 2 diabetes on postoperative outcomes after endovascular aortic aneurysm repair – a cohort study
DOI:
https://doi.org/10.48750/acv.617Keywords:
Abdominal aortic aneurysm, post-operative complications, diabetes mellitus, anti-diabetic drugsAbstract
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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