Gender differences in endovascular abdominal aortic aneurysm repair with the AneuRx stent graft

Objective: The objective of this study was to evaluate gender differences in the selection, procedure, and outcome of endovascular abdominal aortic aneurysm repair (EVAR). Patients. Between October 1996 and January 2001, 378 patients were evaluated for EVAR and 189 patients underwent EVAR with the Medtronic AneuRx stent graft at a single center. Results. Women constituted 17% of patients considered for EVAR. Their eligibility rate (49%) did not differ significantly from that of men (57%), and they constituted 14% of patients who underwent EVAR (26/189). Women who underwent EVAR were older (77.9+/-6.3 years versus 73.1+/-8.1 years; P<.005) with a higher rate of chronic obstructive lung disease (50% versus 28%; P<.05). Maximal aneurysm diameter (57.2+/-10.9 mm versus 57.8+/-9.4 mm; not significant) did not differ between men and women. Mean diameters of the proximal neck (20.4+/-2.3 mm versus 22.3+/-2.0 mm; P<.01), common iliac arteries (11.4 +/- 1.2 mm versus 13.5 +/- 3.6 mm; P<.001), and external iliac arteries (7.9+/-0.7 mm versus 9.4+/-1.4 mm; P<.001) were all smaller in women, and abdominal aortic aneurysm/neck diameter ratio was larger (2.82 +/- 0.59 versus 2.60 +/- 0.49; P<.05). The length of the proximal aortic neck was shorter in women (20.7+/-8.2 mm versus 24.5+/-11.8 mm; P<.05). Women had significantly more intraoperative complications (31% versus 13%; P<.05), primarily related to arterial access, and needed more frequent arterial reconstruction (42% versus 21%; P<.05), without a difference in postoperative mortality rate (0/26 versus 2/163; not significant) and complication rate (23% versus 20%: not significant). During a follow-up period of 13.8 +/- 11.7 months, no gender-related difference was found in survival rate, endoleak rate, or reintervention rate or in the rate of change in aneurysm diameter or volume. Conclusion: Eligibility rates of women for EVAR are similar to those of men. Women are at an increased risk for access-related complications during EVAR, but outcome is equivalent to that of men.