Outcomes after endovascular abdominal aortic aneurysm repair are equivalent between genders despite anatomic differences in women.

OBJECTIVE: Prior work confirms gender-specific anatomic differences in patients undergoing endovascular aneurysm repair, but the clinical implications remain ill defined. The purpose of this study was to compare gender-specific early outcomes after endovascular aneurysm repair using a large international registry. METHODS: Over the 2-year period ending in 2011, 1,262 patients (131 women, 10.4%; 1,131 men, 89.6%) with infrarenal aneurysms treated with the Endurant stent graft were prospectively enrolled in the ENGAGE registry and followed clinically and radiographically. RESULTS: Women were older (75.5 ± 7.0 vs 72.8 ± 8.1; P = .0003) and had smaller aneurysms (57.8 ± 9.5 vs 60.6 ± 11.9 mm; P = .01). Women's infrarenal aortic necks were of narrower diameter (21.8 ± 3.4 vs 24.0 ± 3.5 mm; P < .0001), shorter length (24.3 ± 11.8 vs 27.3 ± 12.4 mm; P = .009), and greater angulation (37.7 ± 26.2° vs 29.4 ± 23.3°; P = .0002). More women had an infrarenal neck angle >60° (19.2% vs 9.1%; P = .001). Technical success was achieved in equal numbers of women and men (97.7% vs 99.2%; P = .10). On completion angiography, the incidence of any endoleak (21.5% vs 15.4%; P = .08) and type I endoleak (1.5% vs 1.1%; P = .60) did not differ between genders. At the 1-month follow-up, there were no differences between women and men with respect to endograft occlusion (2.5% vs 1.9%; P = .70), and differences observed in any endoleak (17.2% vs 11.4%; P = .08) and type I endoleaks (3.3% vs 1.2%; P = .08) did not reach statistical significance. Freedom from major adverse events was similar for women and men at 30 days (98.5% vs 95.8%; P = .23) and 1 year (85% vs 89.8%; P = .40). Survival at 30 days (100% vs 98.6%) and 1 year (92.5% vs 91.6%; P = .99) was similar for women and men. CONCLUSIONS: This large multinational registry confirms the previously observed prevalence of suboptimal neck anatomy in women. Even though women have shorter and more angulated infrarenal necks, their technical outcomes at 30 days and clinical outcomes at 1 year were similar to those of men. Much longer follow-up is necessary to determine whether these outcomes proved durable.

Racial diferences in tooth crown size gradients within morphogenetic fields / Diferencias raciales en el gradiente del tamaño de la corona dental dentro de los campos morfogenéticos

Los dientes se arreglan en campos morfogenéticos, los cuales son ubicaciones anatómicas en los maxilares que regulan tipos de dientes, específicamente incisivos, caninos, premolares y molares en primates. Cada campo está compuesto por dos o tres dientes (salvo el canino aislado), y hay una gradiente de tamaño característica correspondiente a la direccionalidad dentro de cada campo, generalmente con el diente mesial siendo más grande y más estable que el diente distal, variable. El presente estudio se enfoca en las diferencias raciales en la inclinación de las gradientes mesiodistales del tamaño coronal. Grupos con gradientes “inclinadas” demuestran una reducción apreciable del tamaño desde el diente estable al variable, mientras que otros grupos, con gradientes “planas”, tienen dimensiones coronales más similares a través del campo. Esta encuesta de estudios publicados en todo el mundo (107 grupos) evalúa variación entre grupos (en vez de entre individuos) de las gradientes calculadas para los incisivos, premolares y molares en cada arcada. Los caucásicos suelen tener las gradientes más inclinadas; los indígenas de Australia las más planas. Las correlaciones entre las diferentes gradientes de los distintos tipos de diente son significativos estadísticamente, pero menores, lo cual sugiere que factores microevolucionarios han influido sobre las gradientes de los distintos grupos de maneras diferentes. De los siete grupos geográficos evaluados, los Amerindios son los más distintivos. Especulamos brevemente sobre la naturaleza del señalamiento molecular en el desarrollo que determina estas gradientes.

Teeth are arranged in morphogenetic fields, which are anatomical locations in the jaws that regulate tooth types, namely incisors, canines, premolars, and molars in primates. Each field is composed of two or three teeth (except for the isolated canine), and there is a characteristic size gradient corresponding to directionality within each field, generally with the mesial tooth being larger and more stable than the distal, variable tooth. Focus of the present study is on racial differences in the steepness of these mesial-distal crown size gradients. Groups with “steep” gradients have appreciable size reduction from the stable to the variable tooth, while other groups, with “shallow” gradients, have more similar crown dimensions across a field. This worldwide survey of published studies (107 groups) assessed intergroup (rather than inter-individual) variation in size gradients calculated for the incisors, premolars, and molars in each arcade. Caucasians tend to have the steepest gradients; aboriginal Australians tend to have the most shallow gradients. Correlations among the gradients of different tooth types are significant statistically, but modest, suggesting that microevolutionary factors have influenced the gradients of different groups differently. Of the seven geographic groupings evaluated, Amerindians are the most distinctive. We briefly speculate on the nature of the developmental molecular signaling that determines these gradients.