title: Gender Differences in Aortic Neck Morphology in Patients with Abdominal Aortic Aneurysms Undergoing Elective Endovascular Aneurysm Repair.
abstract: BACKGROUND
  Previous studies have demonstrated that women tend to have adverse aortic neck morphology leading to exclusion of some women from undergoing endovascular aneurysm repair (EVAR). The objective of this study is to investigate differences in aortic neck morphology in men versus women, changes in the neck morphology and sac behavior after EVAR, and investigate how these features may influence outcomes.
  
  
  METHODS
  We conducted a retrospective review of elective EVARs (2004-2013). We excluded patients who underwent elective EVAR with no postoperative imaging available and those patients with fenestrated repairs. Using TeraRecon and volumetric analysis, several features were investigated. These included percent thrombus, shape, length, angulation of the neck, and changes in neck and abdominal aortic aneurysm diameter.
  
  
  RESULTS
  A total of 146 patients were found to meet inclusion criteria (115 men and 31 women) with similar baseline characteristics. Neck angulation was greater in women (23.9° vs. 13.5°; P < 0.028). The percent thrombus in women was higher than men (35.4% vs. 31%; P < 0.02). Abdominal aneurysm's were smaller in women at 1 year (4.2 cm vs. 5.1 cm; P < 0.002), and secondary interventions were higher in men (11.3% vs. 0%; P < 0.05). Other features such as neck shape, changes in neck diameter, neck length, and percent oversizing of graft where not statistically different between genders.
  
  
  CONCLUSIONS
  Gender differences in neck characteristics and changes in neck morphology do not appear to adversely affect EVAR outcomes. Longer follow-up is necessary to further assess whether these findings are clinically durable.
authors.affiliation: Division of Vascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY. Electronic address: diegoayo11@gmail.com.
authors.forename: Diego
authors.initials: D
authors.lastname: Ayo
authors.affiliation: Division of Vascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY.
authors.forename: Sheila N
authors.initials: SN
authors.lastname: Blumberg
authors.affiliation: Division of Vascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY.
authors.forename: Byron
authors.initials: B
authors.lastname: Gaing
authors.affiliation: Division of Vascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY.
authors.forename: Andrew
authors.initials: A
authors.lastname: Baxter
authors.affiliation: Division of Vascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY.
authors.forename: Firas F
authors.initials: FF
authors.lastname: Mussa
authors.affiliation: Division of Vascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY.
authors.forename: Caron B
authors.initials: CB
authors.lastname: Rockman
authors.affiliation: Division of Vascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY.
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Maldonado
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D017558:Elective Surgical Procedures; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013927:Thrombosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D016896:Treatment Outcome