Women With Abdominal Aortic Aneurysms Have More Extensive Aortic Neck Pathology
| Autor: | Liya Vishnevskaya, Rebecka Hultgren, Carl-Magnus Wahlgren |
|---|---|
| Rok vydání: | 2013 |
| Předmět: |
Male
medicine.medical_specialty Pathology Short neck Computed tomography 030204 cardiovascular system & hematology 030230 surgery 03 medical and health sciences 0302 clinical medicine medicine Humans In patient Thrombus Aorta Aged Aged 80 and over medicine.diagnostic_test business.industry Endovascular Procedures General Medicine Middle Aged Neck anatomy medicine.disease Abdominal aortic aneurysm Surgery cardiovascular system Open repair Female Radiology Cardiology and Cardiovascular Medicine Aortic neck business Aortic Aneurysm Abdominal |
| Zdroj: | Annals of Vascular Surgery; Vol 27 |
| ISSN: | 0890-5096 |
| DOI: | 10.1016/j.avsg.2012.05.025 |
| Popis: | The proportion of women with abdominal aortic aneurysm (AAA) treated with endovascular aortic repair (EVAR) is lower than for open repair (OR). Unfavorable morphologic features for EVAR in women with AAA may explain this disproportion. The objective of this study was to identify morphologic features in AAA patients undergoing elective repair with special emphasis on gender differences.Patients undergoing elective repair from January 1, 2006 to December 31, 2008 at our university's vascular unit were included in this study. Computed tomography (CT) angiograms were analyzed. Morphologic features considered unfavorable for EVAR rather than open repair (OR) included: infrarenal aortic neck15 mm; angulation60°; circumferential neck thrombus; neck width32 mm; iliac arteries7.5 mm; or presence of bi-iliac aneurysms. Complex aortic neck was defined as a neck length of15 mm and one or more of the other aortic neck exclusion criteria.One hundred seventy-two patients, including 140 men and 32 women, were treated during the study period, which included 99 with OR (21 women, 78 men) and 73 with EVAR (11 women, 62 men). Morphologic unsuitability for EVAR was 44% (75 of 172) and was not statistically different between women and men [47% (15 of 32) vs. 43% (60 of 140), P = 0.70]. Aortic neck pathology was the dominating feature for unsuitability for EVAR (69 of 75, 92%), and 85 of 172 patients had an unsuitable aortic neck. This rate was not different between women and men [19 of 32 (59%) vs. 66 of 140 (47%), P = 0.24]. Iliac unsuitability rates were 11% (19 of 172) and were not different between women and men [4 of 32 (12%) vs. 15 of 140 (11%), P = 0.76]. In patients unsuitable for EVAR, the proximal aortic necks showed more extensive aortic neck pathology in women than in men [8 of 15 (53%) vs. 13 of 60 (22%), P = 0.02]. More men had only short neck pathology [22 of 60 (37%) vs. 1 of 15 (7%), P = 0.03].Aortic neck pathology is the dominating cause of EVAR exclusion in both genders. A higher proportion of women have more pathologic neck anatomy. Future development of EVAR devices should focus on the complexity of the aortic neck, which will benefit all AAA patients, but especially women. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|