Most infrarenal AAAs (66%) can be treated with endovascular devices currently available commercially or through US Food and Drug Administration-approved clinical trials. However, patients who are at high risk for surgery and might benefit most from endovascular repair are less likely to qualify for the procedure (49%). Men (70%) are more likely than women (40%) to meet the anatomic criteria for endografting. Difficulties with vascular access and attachment site geometry predominate as reasons for exclusion. Our findings suggest that smaller profile devices, which can negotiate small and tortuous iliac arteries, are needed. Proximal and distal attachment site problems require devices that can accommodate wide and angulated attachment necks and achieve short seal zones.

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Although initial LOS was shorter for the patients who underwent endovascular as compared with conventional AAA repair, this advantage was lost during the follow-up interval because of frequent readmission for the treatment of procedure-related complications, chiefly endoleak. These readmissions frequently involved the performance of additional invasive procedures. Gender differences existed regarding LOS and the likelihood of complications after open and endovascular AAA repair.

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The aggressive cattail species Typha X glauca and Typha angustifolia have established in wetlands across the Great Lakes region, decreasing native plant diversity and altering environmental conditions. We relied on a parallel study in which 80 years of historical aerial photographs from a large Lake Michigan wetland complex were used to map the spread and determine the age of invasive cattail stands. Floristic, edaphic, and environmental data were collected from plots across an invasion-age gradient. Compared with reference uninvaded sites, litter mass more than doubled within 10 years of invasion (P< 0.001), plant diversity declined by more than 50% within 25 years of invasion (P=0.003), and soil organic depth was more than 29-cm deeper in areas invaded for more than 35 years compared with areas invaded for 10 years or less (P=0.006). These time-dependent changes in plant communities, soil, and environmental conditions fundamentally alter the structure of invaded wetlands, likely influencing a range of ecosystem services.

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