Gender Related Differences in Iliofemoral Arterial Anatomy among AAA patients

• Published in: Annals of vascular surgery
• Main Authors: Tran, Kenneth, MD, Dorsey, Chelsea, MD, Lee, Jason T., MD, Chandra, Venita, MD
• Format: Journal Article
• Language: English
• Published: 2017
• Subjects: Surgery
• ISSN: 0890-5096; 1615-5947
• DOI: 10.1016/j.avsg.2017.01.025

OBJECTIVES Gender related differences in iliofemoral anatomy are critically important for delivery of modern EVAR devices, however remains poorly characterized in the context of other patient-specific factors. The goal of the present study was to provide a detailed quantification of anatomic differences in iliofemoral anatomy between genders while controlling for height, weight and vascular comorbidities. METHODS Fifty women with CT-angiograms for evaluation of AAA between 2000-2012 were selected and matched to an equal non-paired cohort of males with similar age, body-mass indices (BMI), and prevalence of vascular comorbidities (e.g. coronary artery disease, peripheral vascular disease). A 3D workstation was used to measure outer and inner diameters at anatomic reference locations at the common iliac (CI), external iliac (EI), and common femoral (CF) arteries. Iliac aneurysms were excluded from analysis. Multivariate analysis-of-covariance models were employed for evaluating CI, EI, and CF diameters as dependent variables. RESULTS Luminal diameters were significantly smaller at the CI (8.8 vs 11.8mm, p<.001), EI (7.0 vs. 8.4mm, p<.001), and CF (6.7 vs. 9.5mm, p<.001) arteries between men and women despite similar BMIs (27.7 vs. 27.5, p=.20). Similar statistically significant differences were found between men and women when comparing adventitial diameters (p<.001), however not when comparing degrees of stenosis (defined as outer diameter minus inner diameter (p = 0.96)). Female gender was negatively correlated with luminal diameter at the CI (-2.34 [-3.72 - -0.96]; coef. [95% C.I.]), EI (-0.95 [-1.8 - -0.04]), and CF (-2.61 [-3.51 - -1.71]) arteries. Weight (per 10 kg) was positively correlated with luminal diameters measured at the CIA (0.41 [0.12– 0.68]) and CFA (0.35 [0.16-0.53]). No independent relationships between height, vascular comorbidities and arterial diameters were identified. 24% (n=12) of females compared to only 14% (n=7) of males in this study would have been ineligible for EVAR with current devices due to poor iliac access criteria. CONCLUSIONS Women have significantly smaller iliofemoral arterial systems compared to men, even after controlling for height, weight and other comorbidities that are known to affect vascular anatomy. This quantifiable difference in arterial anatomy is important to consider when deciding between various open versus endovascular treatment strategies for women.