The Influence of Female Gender on the Outcome of Endovascular Abdominal Aortic Aneurysm Repair

Mathison, Megumi; Becker, Gary J.; Katzen, Barry T.; Benenati, James F.; Zemel, Gerald; Powell, Alex; Kovacs, Margaret; Lima, Marjorie M.

doi:10.1016/s1051-0443(07)61589-9

Cited by 41 publications

(31 citation statements)

References 18 publications

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“…Because of the inflexibility of externally supported grafts, this segment of the aorta must not be severely angulated. This requirement may impose a gender bias in patient selection because, in addition to the fact that their small external iliac arteries often present problems with respect to vascular access, women also appear to have a higher prevalence of short, angulated aneurysm necks than (370) were forced to abandon more attempted endograft procedures in women (17%) than in men (2.1%, p less than 0.01). Wolf et al described comparable eligibility rates for endograft repair in women (49%) and men (57%), but the women in this series had a higher incidence of intraoperative complications than men (31% vs. 13%, p less than 0.05) and required more adjunctive arterial reconstructions (42% vs. 21%, p less than 0.05) to correct those complications (371).…”

Section: Endovascular Aortic Aneurysm Repairmentioning

confidence: 99%

ACC/AHA 2005 Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic): Executive Summary A Collaborative Report From the American Association for Vascular Surgery/Society for Vascular Surgery,⁎⁎AAVS/SVS when Guideline initiated, now merged into SVSSociety for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guideline

Hirsch¹,

Haskal²,

Hertzer³

et al. 2006

Journal of the American College of Cardiology

927

180

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Section: Endovascular Aortic Aneurysm Repairmentioning

confidence: 99%

ACC/AHA 2005 Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic): Executive Summary A Collaborative Report From the American Association for Vascular Surgery/Society for Vascular Surgery,⁎⁎AAVS/SVS when Guideline initiated, now merged into SVSSociety for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guideline

Hirsch¹,

Haskal²,

Hertzer³

et al. 2006

Journal of the American College of Cardiology

927

180

View full text Add to dashboard Cite

“…46 The risk of a failed procedure and the need for additional reconstructive procedures are greater in women. 71,72 In a study of 704 cases (98 women) from the Cleveland Clinic, graft limb occlusions were significantly more common in women (11% versus 3.3%; Pϭ0.022). 73 The problems relate not only to smaller access vessels 43 but also to shorter, wider, and more angulated aneurysm necks and possibly a greater likelihood of suprarenal involvement.…”

Section: Gender and Treatmentmentioning

confidence: 99%

“…46,47,74 Nevertheless, the case fatality, endoleak, and late reintervention rates are similar for men and women. 46,[71][72][73] …”

Section: Gender and Treatmentmentioning

confidence: 99%

Abdominal Aortic Aneurysm

2007

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M ost manifestations of cardiovascular disease are more common in men than in women. However, cardiovascular disease is the most common cause of death in women worldwide. 1 Coronary heart disease in women has a worse outcome than in men, and this has attracted considerable attention in recent years, with calls for more gender-specific research. 1,2 Abdominal aortic aneurysms (AAAs) also are less common in women than in men, and, as with coronary heart disease, there is evidence that women with AAA also have a worse prognosis. The present review addresses the epidemiology, development, natural history, management, and outcomes of AAA in women. Prevalence and IncidenceWhen the definition of a maximum external diameter Ն3 cm is used, the prevalence of AAA is up to 6 times greater in men than in women. 3,4 In a community-based screening study of the older population, the prevalence of AAA was 1.3% in women compared with 7.6% in men. 4 Similarly, the ratio of men to women in surgical series is Ϸ5:1. 5-7 Because of the relatively low prevalence, women were excluded from the large trials of screening for AAA. 8 -10 The prevalence in women from families with a strong history of AAA may be as high as 8.3%, and these women should be offered screening. 11 Modeling studies have indicated that screening for AAA in women could be cost-effective because the rupture rate appears to be much higher in women than in men. 12 The incidence of AAA has continued to rise over the last 4 decades. [13][14][15][16] Initially, a similar pattern was seen in both genders, although the increase in mortality and admission rate has been become more marked in women. 15,16 Inspection of data derived from national (England and Wales) statistics shows that the annual number of hospital admissions for aneurysm rupture between 1997 and 2005 has declined by 2% to 3% per annum in men. 17 In women, although the total number of admissions for ruptured AAA is Ϸ40% of male admissions, there has been an increase of Ϸ0.5% per annum since 2005. The reasons for this are unknown. Population screening for AAA in men is not yet widespread in England and Wales and is unlikely to have made a major contribution to these trends. However, AAA appears to be a late event after smoking exposure, and these trends may reflect temporal changes in smoking prevalence. The rise of smoking in women occurred over the period 1950 to 1970, several decades after the widespread uptake of smoking by men. Since then, rates of cessation have been greater in men than in women. 18 The presence of an AAA is associated with aneurysms of the iliac, femoral, and popliteal arteries, but, compared with AAA, all of these have a higher incidence ratio in men versus women. 19 However, some aneurysms are found predominantly or equally in women, with splenic 20 and cerebral artery 21 aneurysms being respective examples. Natural History: Expansion and RuptureThere is no good evidence to suggest that aneurysm growth rate is different in men and women. 22 Although a single small study suggested that ...

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“…The assessment begins with consideration of the body habitus and sex of the patient; small body size and female sex have been associated with a higher risk of procedure abortion. 25,26 In addition, the comorbidities of the patients must be assessed, with careful attention to cardiac, pulmonary, and renal conditions. In general, open surgical repair is advocated for younger, lower-risk patients, and EVAR is preferred for older, higher-risk patients.…”

Section: Clinical and Anatomic Selection Factorsmentioning

confidence: 99%