Mortality for females undergoing elective EVAR is significantly greater than for males. It is also more hazardous. Colon ischemia, native arterial rupture, and type 1 endoleaks are more frequent. Elective endovascular aneurysm repair benefits men more than women.

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Introduction and objectives:Although female gender has been implicated as a risk factor for AAA repair, the etiologies for this gender difference remains ill defined. We prospectively analyzed variables that might impact the aneurysm-related morbidity and mortality in women.Methods: From 2002 to 2009, 2631 consecutive AAA patients undergoing open surgical and endovascular aneurysm repair (EVAR) were entered into a registry based on female (n ϭ 636, 24%) vs male (n ϭ 1995, 76%) gender. Data were prospectively collected and all variables analyzed.Results: Of the 2631 AAA patients, both genders were comparable with respect to demographics with one exception: women had a higher incidence of COPD (24% vs 15%, P Ͻ .05). A higher percentage of women presented with AAA rupture (14% vs 8%, P Ͻ .05). Compared with men, women undergoing EVAR had a significant higher mortality (elective EVAR: 3.2% vs 0.9%; emergent EVAR: 27.3% vs 17.2%; all EVAR: 5.3% vs 1.9%, P Ͻ .05), arterial rupture (4.1% vs 1.2%, P Ͻ .05), postoperative bleeding (4.9% vs 2.9%, P Ͻ .05), lower extremity ischemic complications (3.5% vs 0.6%, P Ͻ .05), ischemic colitis (4.1% vs 1.2%, P Ͻ .05), Palmaz stent placement for type I endoleak (16.3% vs 7.2%, P Ͻ .05), and mean hospital length of stay (4.1 vs 1.8 days, P Ͻ .05). These gender differences were not significant in the elective and emergent open surgical groups. At a mean follow-up of 26 months, there were no gender differences in survival, secondary interventions, or freedom from aneurysm rupture.Conclusions: A higher percentage of women present with aneurysm rupture. When treated by endovascular means, in comparison with men, women have higher procedurally related morbidity of intraoperative arterial rupture, postoperative bleeding, lower extremity ischemic complications, ischemic colitis, and type I endoleaks requiring adjunctive procedures. These findings suggest the need for improvements in stent graft design and EVAR procedures that are better suited for women.

CORRESPONDENCE BRInsH 343 MEDICAL JOURNAL anxiety impose on the kidney a cortical ischaemia-a renal change for which there is both direct and indirect proof in pre-eclampsia.`' Psychosomatic disorders, where a plausible transfer of the appetite centre to the cortex-with its implicit consequent voraciousness-as a result of emotional shock, may well explain certain cases of obesity, but hardly pre-eclampsia, for which Dr. Wood advances them as a cause. There is no evidence I am aware of that successfully supports the contention that toxaemia of pregnancy is an endocrinal disorder. Dr. Wood does, however, correctly contend that weight restriction in itself is not the specific prophylactic. The reduced circulation of the renal cortex is the immediate physio-pathological change responsible for the signs of pre-eclampsia. and for this the utero-renal reflex is in turn responsible. Treatment apparently directed towards obesity, or to an alleged dietetic aetiological factor, can be shown to owe its value almost entirely to its beneficial influence on the ischaemic pattern of the renal circulation, whose duality-difficult to uncover-Trueta' and Pappenheimer7 have importantly explained.-I am, etc., London, W.1.

Conclusions:Routine CT scans for surveillance after EVAR increases risk for acquiring leukemia due to radiation exposure. The risk is higher in the young,females &with contrast CT scans. Routine CT scans should hence be limited to avoid increased risk of malignancy.Model 1: CT Scans at 0,6,12,18,24,36,48 months and yearly after Model2: CT scans at 0,1,12 months and once in 3 years Model3: CT scans at 0,1,12 months and once in 5 years