Impact of Sex-Related Differences in Infrarenal Aortic Neck Morphology on Outcomes of Endovascular Aneurysm Repair for Similar-Sized Aortic Aneurysm

Ombretta Martinelli ¹, Antonio Marzano ¹, Maria Irene Bellini ²

⁰Vascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I-"La Sapienza" University of Rome, Viale del Policlinico, 00161 Rome, Italy.

Diagnostics (basel, Switzerland) +

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January 25, 2025

View abstract on PubMed

Summary

Women with abdominal aortic aneurysms (AAA) often have challenging anatomy for endovascular aortic aneurysm repair (EVAR). Despite this, EVAR shows comparable success and long-term outcomes in women compared to men, highlighting effective planning and expertise.

Area Of Science

Vascular Surgery
Medical Engineering
Anatomy

Background

Gender-related anatomical variations in the proximal aortic neck can impact endovascular aortic aneurysm repair (EVAR) feasibility and outcomes.
Understanding these differences is crucial for optimizing EVAR in female patients with abdominal aortic aneurysms (AAA).

Purpose Of The Study

To evaluate if gender-specific proximal aortic neck anatomy influences the success and outcomes of EVAR in women with AAA.
To compare EVAR feasibility and results between male and female patients.

Main Methods

Retrospective analysis of 117 patients undergoing elective EVAR for infrarenal AAA (2019-2023).
Analysis of demographics, proximal aortic neck morphology, stent graft details, and adherence to instructions for use (IFUs).
Primary endpoint: technical success. Secondary endpoints: reinterventions, endoleak rates, and aneurysm-related mortality.

Main Results

Female patients exhibited a higher prevalence of hostile proximal aortic neck features (shorter length, greater angulation) and more off-label EVAR procedures.
Overall technical success was high (98.3%) with no significant gender differences in stent graft selection, suprarenal fixation, or type 1-3 endoleaks.
Off-label EVAR was an independent risk factor for type 1A endoleaks, reinterventions, and aneurysm-related mortality.

Conclusions

Female patients often present with more challenging aortic neck anatomy for EVAR but achieve comparable technical success and mid- to long-term outcomes to men.
Effective procedural planning, device selection, and surgical expertise can overcome anatomical challenges.
Further large-scale studies are needed to confirm if anatomical factors alone influence outcomes regardless of gender.

Keywords:

abdominal aortic aneurysm endovascular repair gender-related aortic neck anatomy neck-related outcomes off-label EVAR