Endovascular abdominal aortic aneurysm repair: does gender matter?

Area of Science:

• Vascular Surgery
• Medical Engineering
• Gender-Specific Medicine

Background:

• Cardiovascular diseases exhibit significant gender-based differences in natural history and clinical progression.
• Endovascular Abdominal Aortic Aneurysm Repair (EVAR) is a common treatment, but its comparative effectiveness across genders requires further investigation.

Purpose of the Study:

• To compare preoperative characteristics, intraoperative events, and postoperative outcomes between men and women undergoing elective EVAR.
• To test the hypothesis that EVAR achieves similar results across genders, despite anatomical variations.

Main Methods:

• Retrospective review of 241 consecutive patients undergoing elective EVAR from December 1996 to May 2003.
• Analysis of demographic data, comorbidities, intraoperative events, and preoperative computed tomography (CT) scans for anatomical assessment.
• Evaluation of radiologic outcomes from postoperative CT scans and clinical follow-up data.

Main Results:

• Women (12% of cohort) were older and presented with narrower, shorter proximal necks and smaller, more calcified iliac arteries compared to men.
• Women required more frequent additional access maneuvers, including iliac angioplasty and chimney grafts, with a trend towards longer fluoroscopy times.
• At 24 months, women and men showed similar rates of freedom from endoleak, reintervention, aneurysm shrinkage, expansion, and survival.

Conclusions:

• Women undergoing EVAR have distinct anatomical features, including narrower necks and iliac arteries, necessitating more complex access strategies.
• Despite these anatomical challenges and older age, women achieve comparable technical and clinical outcomes to men following EVAR.
• EVAR is a viable and effective treatment option for abdominal aortic aneurysms in both genders, with similar long-term results.