The Protective Effects of Diabetes Mellitus on Post EVAR AAA Growth and Reinterventions

Abstract Introduction and Objective This study aims to investigate the effect of diabetes on post-endovascular aneurysm repairs (EVAR) of abdominal aortic aneurysms (AAA). Methods 1479 consecutive patients who underwent AAA EVAR were reviewed. The cohorts were divided based on their diabetes status and compared. Preoperative demographic and comorbidity data were analyzed using t-test and Chi-squared test while post-EVAR outcomes were analyzed using Probit multivariate model, followed by Kaplan Meier survival curve and Cox regression. Results Of our 1479 patients, 993 met inclusion criteria. 183 were diabetics (18.4%), compared to 810 non-diabetics (81.6%). Coronary artery disease (Diabetics: 70.49%, Non-diabetics: 60.76%, p= 0.014) and hypertension (Diabetics: 90.16%, Non-diabetics: 79.46%, p= 0.0008) were the only comorbidities analyzed, including follow-up length, which had any significant differences between the diabetic and non-diabetic groups. Probit multivariate analysis using a combined cohort follow-up mean of 51 months showed a significant decrease in aneurysm sac enlargement in diabetic patients (Diabetics: 13.11%, Non-diabetics: 19.43%, model estimate: 0.3058; 95% CI, 0.0486—0.5629, Pr > ChiSq = 0.0198) and trended towards significantly fewer reinterventions (Diabetics: 23.50%, Non-diabetics: 28.41%, model estimate: 0.1990; 95% CI, -0.0262—0.4243, Pr > ChiSq = 0.0833). In the Cox regressions, diabetes had a significant protective factor on reinterventions (HR: 0.697, Pr > ChiSq = 0.0151), and was trending towards significance for aneurysm sac enlargement (HR: 0.750, Pr > ChiSq = 0.1961). There was no significant difference across diabetic status in any other outcomes, including mortality and endoleak occurrence. Conclusion Though a higher proportion of diabetic patients present with HTN and CAD, they have decreased long-term rates of aneurysm sac enlargement post-EVAR. As a result, this cohort trends towards a lower need for reintervention post-EVAR.