Aortic endograft infection can be eradicated by excision and in situ or extra-anatomic replacement but is often associated with early postoperative morbidity and mortality and occasionally with a need for late removal for reinfection. Prosthetic graft replacement after explanation is associated with higher reinfection and graft-related complications and decreased survival compared with autogenous reconstruction.

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In veterans deemed high-risk for surgical therapy, outcomes after elective EVAR are excellent, and the procedure is relatively safe in this special patient population. Our retrospective data demonstrate that patients with considerable medical comorbidities and infrarenal abdominal aortic aneurysms benefit from and should be considered for primary EVAR.

Background and Purpose Differences in ischemic stroke (IS) between men and women have been mainly attributed to hormonal effects. However, sex differences in immune response to ischemia may exist. We hypothesized that differential expression of X-chromosome genes in blood immune cells contribute to differences between men and women with IS. Methods RNA levels of 683 X-chromosome genes were measured on Affymetrix U133 Plus2.0 microarrays. Blood samples from IS were obtained at ≤3h, 5h and 24h (n=61; 183 samples) following onset and compared to controls without symptomatic vascular diseases (n=109). Sex difference in X-chromosome gene expression was determined using ANCOVA (FDR≤0.05, |fold change|≥1.2). Results At ≤3, 5 and 24h after stroke there were 37, 140 and 61 X-chromosome genes, respectively, that changed in women; and 23, 18 and 31 X-chromosome genes that changed in men. Female-specific genes were associated with post-translational modification, small-molecule biochemistry and cell-cell signaling. Male-specific genes were associated with cellular movement, development, cell-trafficking and cell death. Altered sex specific X-chromosome gene expression occurred in two genes known to be associated with human stroke including GLA and IDS, mutations of which result in Fabry's Disease and Hunter Syndrome, respectively. Conclusions There are differences in X-chromosome gene expression between men and women with ischemic stroke. Future studies are needed to decipher whether these differences are associated with sexually dimorphic immune response, repair or other mechanisms following stroke, or whether some of them represent risk determinants.