Gender-related differences in infrarenal aortic aneurysm morphologic features: Issues relevant to Ancure and Talent endografts

Purpose: The purpose of this study was to determine whether gender-related anatomic variables may reduce applicability of aortic endografting in women . Methods: Data on all patients evaluated at our institution for endovascular repair of their abdominal aortic aneurysm were collected prospectively. An cure (Endovascular Technologies (EVT)/Guidant Corporation, Menlo Park, Cali f) and Talent (World Medical/Medtronic Corporation, Sunrise, Fla) endograft s were used. Preoperative imaging included contrast-enhanced computed tomog raphy and arteriography or magnetic resonance angiography. Results: One hundred forty-one patients were evaluated (April 1998-December 1999), 19 women (13.5%) and 122 men (86.5%). Unsuitable anatomy resulted i n rejection of 63.2% of the women versus only 33.6% of the men (P = .026). Maximum aneurysm diameter in women and men were similar (women, 56.94 +/- 8 .23 mm; men, 59.29 +/- 13.22 mm; P = .5). The incidence of iliac artery tor tuosity was similar across gender (women, 36.8%; men, 54.9%; P = .2). The n arrowest diameter of the larger external iliac artery in women was signific antly smaller (7.29 +/- 2.37 mm) than in men (8.62 +/- 2.07 mm; P = .02). T he proximal neck length was significantly shorter in women (10.79 +/- 12.5 mm) than in men (20.47 +/- 19.5 mm; P = .02). The proximal neck width was s ignificantly wider in women (30.5 +/- 2.4 mm) than in men (27.5 +/- 2.5 mm; P = .013). Proximal neck angulation (>60 degrees) was seen in a significan tly higher proportion of women (21%) than men (3.3%; P = .012). Of the pati ents accepted for endografting, a significantly higher proportion of women required an iliofemoral conduit for access (women, 28.6%; men, 1.2%; P = .0 16). Conclusion: Gender-related differences in infrarenal aortic aneurysm morpho logic features may preclude widespread applicability of aortic endografting in women, as seen by our experience with the Ancure and Talent devices. In addition to a significantly reduced iliac artery size, women are more like ly to have a shorter, more dilated, more angulated proximal aortic neck.