Effect of vertebral compression fractures on aortic neck angulation after endovascular aneurysm repair.

OBJECTIVE: Aortic neck angulation (ANA) prior to endovascular aneurysm repair (EVAR) and its changes after EVAR are considered important predictors of post-operative complications. We sought to assess the effects of vertebral body height loss on ANA in patients post-EVAR.

METHODS: All patients who had undergone EVAR for infrarenal aortic aneurysms in our institution between August 2010 to December 2018 were assessed. Anterior and posterior vertebral body heights were measured in all patients on pre-operative, early post-operative, and follow-up CT scans (T12 - L5 vertebral bodies). Patients who had significant height loss in their follow-up period were designated as the Study group. These were matched to a Control group of same size using propensity-score matching based on age, gender, and duration between follow-up scans. Aortic neck morphology indices including ANA and its changes were measured, and information related to post-operative endoleaks and aneurysm sac size were extracted in the Study and Control groups.

RESULTS: During follow-up period, 10 out of 185 patients had a radiologically significant vertebral body compression fracture. There was no significant difference between the Study (N=10) and Control groups in age (77.6 ± 6.9 years vs. 77.2 ± 7.5 years; P = .64), gender (7 males and 3 females in each group, P = 1.0), duration between post-operative scans (1830 ± 665 days vs. 1800 ± 670 days; P = .25), pre-operative ANA (36.0° ± 15.6° vs. 42.4° ± 18.6°; P = .41), and early post-operative ANA (21.9° ± 11.7° vs. 20.9° ± 16.3°; P = .72). Changes in ANA in the post-operative period (7.2° ± 11.1° vs. -4.7° ± 6.7°; P = .009; power = .838) were significantly higher in the Study group.

CONCLUSION: Post-EVAR vertebral body compression fractures exacerbate ANA. Awareness of this can guide both pre-operative assessment and post-operative management and follow-up.