The influence of gender and aortic aneurysm size on eligibility for endovascular abdominal aortic aneurysm repair

Abstract

Women are significantly less likely to meet device IFU criterion for EVAR. Aortic neck criteria and iliac access are important for men and women, but more women than men fail to meet IFU criterion. Devices that accommodate shorter infrarenal AAA neck length will have the greatest impact on expanding on-label EVAR regardless of gender. Lower profile devices and those that accommodate higher neck angulation are expected to expand EVAR eligibility further for women. EVAR eligibility is unlikely to be lost as AAAs enlarge to 5.5 cm in women and 6.5 cm in men. Observation of small AAAs until they reach the standard threshold size for repair should not compromise EVAR eligibility.

Morphological suitability for endovascular repair, non-intervention rates, and operative mortality in women and men assessed for intact abdominal aortic aneurysm repair: systematic reviews with meta-analysis

“…After our search and evaluation (appendix), five papers based on five studies [13][14][15][16][17] were eligible for inclusion in the meta-analysis regarding suitability for endovascular repair. Another study 18 also included suitability for endovascular sealing technology, but used a selected population.…”

“…The criteria of morphological suitability for EVAR were different in each study; three studies 13,15,16 included all the aneurysms diagnosed (including those not offered intervention), one study 17 did not specify which patients Non-intervention review (565 titles): endovascular procedures/stents/vascular surgical procedures/blood vessel prosthesis/blood vessel prosthesis implantation/vascular grafting; aortic aneurysm, abdominal; female/women/women's health; sex factors/sex distribution/sex ratio/sex characteristics; elective surgical procedures; comorbidity; risk factors/risk assessment; refusal to treat/patient selection; palliative care 30-day operative mortality review (5411 titles): aortic aneurysm, abdominal; blood vessel prosthesis/blood vessel prosthesis implantation/vascular grafting; aortic aneurysm, abdominal-surgery; aortic aneurysm, abdominal-mortality/aortic aneurysm, abdominal-complications/hospital mortality/minimally invasive surgical proceduresmortality/vascular surgical procedures-mortality/vascular surgical procedures-adverse effects; sex factors/sex distribution/sex ratio/sex characteristics; treatment outcome See Online for appendix were being considered for EVAR, and one study 14 only considered patients who had undergone elective repair. The largest study 15 has published two further updates but neither provided sufficient information to merit inclusion in the review. 19,20 Threshold abdominal aortic aneurysm diameter for inclusion ranged from 4 cm to 5 cm.…”

“…For example, in one excluded study 18 of 78 women that considered both conventional endografts and endovascular sealing, 32 (41%) women were suitable for the Gore Excluder graft (Gore Medical, Flagstaff, AZ, USA), but 61 (78%) would have been eligible for endovascular-sealing technology. 18 The largest study 15 investigated how suitability for EVAR declined with increasing aneurysm diameter, with almost no women being considered suitable for EVAR if their abdominal aortic aneurysm diameter cutoff exceeded 6·5 cm compared with 30% of men being suitable. The other four studies 13,14,16,17 provided few demographic or clinical details, so it was not possible to investigate how the suitability for EVAR in women might depend on age or other characteristics.…”

“…Kristmundsson et al (2014) 13 Hultgren et al (2013) 14 Sweet et al (2011) 15 Park et al (2011) 16 Moise et al (2006) a third (34%) of potentially eligible women were either not offered or refused abdominal aortic aneurysm repair. The proportion was about double the non-intervention rate in men (19%; OR 2·27, 95% CI 1·21-4·23; figure 2).…”

Endovascular aneurysm repair with the Ovation TriVascular Stent Graft System utilizing a predominantly percutaneous approach under local anaesthesia

“…6,12 Currently, with the use of the low-profile delivery catheter of the Ovation stent graft, approximately 90% of males and 70% of females with AAA have access vessel diameters amenable to EVAR, while the fact that it is the only endograft approved to treat proximal necks shorter than 10 mm alone might increase EVAR eligibility by about 10%. 13 Furthermore, the ultralow profile delivery system of the Ovation endograft allows for totally percutaneous access and highlights the possibility to perform the procedure under local anaesthesia (LA), which may correlate with fewer systematic complications and reduced procedural times. [14][15][16] In the current study, we aim to present our experience with the Ovation TriVascular Stent Graft system to treat patients with AAA.…”