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 PS6. Population-based Study of Age and Gender Effects in Aneurysm Anatomy

‚ÄčTina M. Morrison1, Xu Yan1, Dorothy B. Abel1, Ron M. Fairman2, Marc H. Glickman3, Mark F. Fillinger4
1Division of Cardiovascular Device - Office of Device Evaluation, Food and Drug Administration, Silver Spring, MD; 2University of Pennsylvania Medical Center, Philadelphia, PA; 3Sentara Norfolk General Hospital, Norfolk, VA; 4Dartmouth-Hitchcock Medical Center, Lebanon, NH.

OBJECTIVES: The FDA is collaborating with clinicians to characterize human aortic anatomy in a population-based study, CHAP, to increase patient eligibility for EVAR and augment endograft (EVG) design and evaluation.

METHODS: Preoperative CT scans from three centers were prospectively entered into a database from 7/96 to 8/10. A blinded third-party, M2S, recorded 25 standardized measurements from the 3D reconstructions. For inclusion, AAA had to be infrarenal and >5 cm, or 4-5 cm if the orthogonal sac diameter was more than twice the normal aortic diameter. The anatomic criteria were analyzed in 1108 men and 357 women with untreated AAA.

RESULTS: Anatomy of men and women with AAA is significantly different in each age category (p<0.005) except for neck length and angulation in the youngest group*. The aortic neck shortens and becomes more angulated with age (p<0.005), especially for women. Other differences between men and women are more consistent by age group.

CONCLUSIONS: Almost all the key anatomic parameters are significantly different between men and women. Some anatomic differences are independent of age, but the disparity in neck length, angulation and access becomes more apparent as patients age, with women having more severe anatomy at all ages. All of these factors lower EVAR eligibility for older patients, especially women, with only 29% of women over 80 years eligible for EVAR based on current EVG's Instructions for Use.

AUTHOR DISCLOSURES: D. B. Abel, Nothing to disclose; R. M. Fairman, Nothing to disclose; M. F. Fillinger, Nothing to disclose; M. H. Glickman, Nothing to disclose; T. M. Morrison, Nothing to disclose; X. Yan, Nothing to disclose.

Mean (and 10th-90th percentile range) anatomic parameters by gender and age

Neck Diameters, mm
24 20-29
24 18-34
24 19-30
26 21-33
26 21-32
26 21-32
Neck Length, mm
17* 4-32
14 4-31
13 3-30
19* 5-35
17 4-35
18 5-39
Angle, deg
38* 17-58
46 27-74
50 27-64
35* 18-57
38 18-61
41 19-65
AO Bifurcation Diameter, mm
20 12-28
19 12-30
19 13-27
24 15-35
22 15-33
22 15-32
Min Com Iliac Diameter, mm
11 7-15
11 8-14
11 8-15
14 10-19
14 11-19
12 11-15
Ave Ext Iliac Diameter, mm
6 5-8
7 5-9
7 5-8
8 7-10
9 7-11
9 7-11
Min Iliac Access, mm
5 3-7
5 4-7
5 4-7
7 6-9
7 6-10
8 5-10


Posted April 2012

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