ORIGINAL ARTICLE   

Minerva Cardioangiologica 2017 August;65(4):348-54

DOI: 10.23736/S0026-4725.17.04321-3

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Combination of endovascular graft exclusion and drug therapy in AAA with hypertension or hyperglycemia

Dile WANG, Bihui QU, Tao HE ✉

Department of Vascular Surgery, Key Laboratory for Molecular Diagnosis of Hubei Province, Wuhan Central Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

BACKGROUND: The objective of the present study was to evaluate the efficacy of combination of endovascular graft exclusion and drugs for hypertension/hyperglycemia for the treatment of abdominal aortic aneurysm (AAA).
METHODS: We analyzed 156 patients with AAA. Eighty-four patients were hypertensive and 72 were hyperglycemic. After endovascular graft exclusion, hypertensive patients were divided into four groups and treated with cyclopenthiazide, reserpine, propranolol, and placebo respectively. Hyperglycemic patients were divided into three groups and treated with metformin, insulin, and placebo respectively. Body temperature and peripheral blood leukocytes were measured at day 1, 2, 7, and 14 after endovascular graft exclusion. Size of AAAs, blood pressure, and blood sugar were measured again after 1 year.
RESULTS: In hypertensive patients, the size of AAAs reduced after endovascular graft exclusion, while the combined treatments with cyclopenthiazide, reserpine, or propranolol helped to reduce blood pressure (blood pressure decrease <10 mmHg (18/21), <10 mmHg (12/21), <10 mmHg (8/21), and <10 mmHg (10/21) in the control group, cyclopenthiazide group, reserpine group, and propranolol group, respectively. AAA size decreased in the control group (P<0.001) and in the other three groups (P<0.0001). Similar results were obtained in hyperglycemic patients. The size of AAAs reduced after endovascular graft exclusion. Combined treatment with Metformin and Insulin reduced blood sugar (control, blood sugar >7.8 mmol/L (22/24), AAA size (P<0.001); metformin, blood sugar >7.8 mmol/L (14/24), AAA size (P<0.0001); insulin, blood sugar >7.8 mmol/L (11/24), AAA size (P<0.0001).
CONCLUSIONS: Combination of endovascular graft exclusion with medicine is more effective than the former treatment alone for AAA therapy.

KEY WORDS: Abdominal aortic aneurysm - Vascular grafting - Drug therapy