Aortic sodium [18F]fluoride uptake following endovascular aneurysm repair

Debono, S. et al. (2023) Aortic sodium [18F]fluoride uptake following endovascular aneurysm repair. Heart, (doi: 10.1136/heartjnl-2023-322514) (PMID:37164479) (Early Online Publication)

Abstract

Objective: In patients with abdominal aortic aneurysms, sodium [18F]fluoride positron emission tomography identifies aortic microcalcification and disease activity. Increased uptake is associated with aneurysm expansion and adverse clinical events. The effect of endovascular aneurysm repair (EVAR) on aortic disease activity and sodium [18F]fluoride uptake is unknown. This study aimed to compare aortic sodium [18F]fluoride uptake before and after treatment with EVAR. Methods: In a preliminary proof-of-concept cohort study, preoperative and post-operative sodium [18F]fluoride positron emission tomography-computed tomography angiography was performed in patients with an infrarenal abdominal aortic aneurysm undergoing EVAR according to current guideline-directed size treatment thresholds. Regional aortic sodium [18F]fluoride uptake was assessed using aortic microcalcification activity (AMA): a summary measure of mean aortic sodium [18F]fluoride uptake. Results: Ten participants were recruited (76±6 years) with a mean aortic diameter of 57±2 mm at time of EVAR. Mean time from EVAR to repeat scan was 62±21 months. Prior to EVAR, there was higher abdominal aortic AMA when compared with the thoracic aorta (AMA 1.88 vs 1.2; p<0.001). Following EVAR, sodium [18F]fluoride uptake was markedly reduced in the suprarenal (ΔAMA 0.62, p=0.03), neck (ΔAMA 0.72, p=0.02) and body of the aneurysm (ΔAMA 0.69, p=0.02) while it remained unchanged in the thoracic aorta (ΔAMA 0.11, p=0.41). Conclusions: EVAR is associated with a reduction in AMA within the stented aortic segment. This suggests that EVAR can modify aortic disease activity and aortic sodium [18F]fluoride uptake is a promising non-invasive surrogate measure of aneurysm disease activity.

• Item Type: Articles
• Additional Information: SD, AJF, MS, MCW, ROF and DEN are supported by the British Heart Foundation (PG/21/10461, FS/19/15/34155, FS/18/31/33676, FS/ICRF/20/26002, RE/18/5/34216, FS/SCRF/21/32010). MRD is the recipient of the Sir Jules Thorn Award for Biomedical Research 2015 (15/JTA). DEN is the recipient of a Wellcome Trust Senior Investigator Award (WT103782AIA). EJRvB is supported by SINAPSE ( www.sinapse.ac.uk).
• Keywords: Aortic aneurysm, positron-emission tomography, endovascular procedures.
• Status: Early Online Publication
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Fletcher, Dr Alexander
• Authors: Debono, S., Nash, J., Fletcher, A. J., Syed, M., van Beek, E. J.R., Williams, M. C., Falah, O., Tambyraja, A., Dweck, M. R., Newby, D. E., and Forsythe, R. O.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Heart
• Publisher: BMJ Publishing Group
• ISSN: 1355-6037
• ISSN (Online): 1468-201X
• Published Online: 10 May 2023
• Copyright Holders: Copyright © 2023 The Authors
• First Published: First published in Heart 2023
• Publisher Policy: Reproduced under a Creative Commons License