title: Outcomes after endovascular abdominal aortic aneurysm repair are equivalent between genders despite anatomic differences in women.
abstract: OBJECTIVE
  Prior work confirms gender-specific anatomic differences in patients undergoing endovascular aneurysm repair, but the clinical implications remain ill defined. The purpose of this study was to compare gender-specific early outcomes after endovascular aneurysm repair using a large international registry.
  
  
  METHODS
  Over the 2-year period ending in 2011, 1,262 patients (131 women, 10.4%; 1,131 men, 89.6%) with infrarenal aneurysms treated with the Endurant stent graft were prospectively enrolled in the ENGAGE registry and followed clinically and radiographically.
  
  
  RESULTS
  Women were older (75.5 ± 7.0 vs 72.8 ± 8.1; P = .0003) and had smaller aneurysms (57.8 ± 9.5 vs 60.6 ± 11.9 mm; P = .01). Women's infrarenal aortic necks were of narrower diameter (21.8 ± 3.4 vs 24.0 ± 3.5 mm; P < .0001), shorter length (24.3 ± 11.8 vs 27.3 ± 12.4 mm; P = .009), and greater angulation (37.7 ± 26.2° vs 29.4 ± 23.3°; P = .0002). More women had an infrarenal neck angle >60° (19.2% vs 9.1%; P = .001). Technical success was achieved in equal numbers of women and men (97.7% vs 99.2%; P = .10). On completion angiography, the incidence of any endoleak (21.5% vs 15.4%; P = .08) and type I endoleak (1.5% vs 1.1%; P = .60) did not differ between genders. At the 1-month follow-up, there were no differences between women and men with respect to endograft occlusion (2.5% vs 1.9%; P = .70), and differences observed in any endoleak (17.2% vs 11.4%; P = .08) and type I endoleaks (3.3% vs 1.2%; P = .08) did not reach statistical significance. Freedom from major adverse events was similar for women and men at 30 days (98.5% vs 95.8%; P = .23) and 1 year (85% vs 89.8%; P = .40). Survival at 30 days (100% vs 98.6%) and 1 year (92.5% vs 91.6%; P = .99) was similar for women and men.
  
  
  CONCLUSIONS
  This large multinational registry confirms the previously observed prevalence of suboptimal neck anatomy in women. Even though women have shorter and more angulated infrarenal necks, their technical outcomes at 30 days and clinical outcomes at 1 year were similar to those of men. Much longer follow-up is necessary to determine whether these outcomes proved durable.
authors.affiliation: Division of Vascular Surgery, London Health Sciences Centre and Western University, London, Ontario, Canada.
authors.forename: Luc
authors.initials: L
authors.lastname: Dubois
authors.forename: Teresa V
authors.initials: TV
authors.lastname: Novick
authors.forename: Jeremy R
authors.initials: JR
authors.lastname: Harris
authors.forename: Guy
authors.initials: G
authors.lastname: Derose
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Forbes
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001027:Aortography; D001208:Asia / Q000453:epidemiology; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D002170:Canada / Q000453:epidemiology; D016009:Chi-Square Distribution; D017558:Elective Surgical Procedures; D057867:Endoleak / Q000401:mortality; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005060:Europe / Q000453:epidemiology; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D011446:Prospective Studies; D011474:Prosthesis Design; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013019:South Africa / Q000453:epidemiology; D013020:South America / Q000453:epidemiology; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome