Gender Related Variation in the Aorto-iliofemoral Arteries in Patients Undergoing Transcatheter Aortic Valve Replacement

Background: Determining aortic valve and vascular size is needed in order to determine feasibility of performing a transcatheter aortic valve replacement (TAVR). Variations in size of the aortic valve and iliofemoral arteries can impact TAVR size and deliverability, respectively. To determine if gender variations exists in the aorto-iliofemoral arteries this study was undertaken.

Methods: One-hundred fifty-one patients undergoing TAVR were studied. Aorta and iliofemoral artery areas were obtained from pre-procedural computed tomography imaging and compared between genders. Specifically, the following areas were determined: aortic annulus (mid systole), sinotubular junction, ascending aorta (4 cm above annulus), right and left common iliac arteries, right and left external iliac arteries, and right and left femoral arteries. Non-adjusted area and adjusted area for body surface area (BSA) were determined.

Results: Non-adjusted areas were significantly greater in men for aortic annulus, sinotubular junction, ascending aorta, left and right iliac arteries, and left and right femoral arteries (5.29±0.83 vs. 4.27±0.78 cm2, p<0.0001; 6.86±1.57 vs. 5.70 ±1.43 cm2, p<0.0001; 8.80±1.69 vs. 7.98±1.64 cm2, p<0.005; 0.52±0.19 vs. 0.42 ±0.15 cm2, p<0.005; 0.50±.016 vs. 0.38±0.13 cm2, p<0.0001, 0.48±0.18 vs. 0.40±0.14 cm2, p<0.005; 0.47±0.16 vs. 0.40±0.12 cm2, p=<0.05, respectively). After adjusting for BSA, areas were significantly greater in men for aortic annulus, sinotubular junction, and left iliac and femoral arteries (2.63±0.42 vs. 2.36±0.36 cm2, p<0.0001; 3.40±0.73 vs. 3.16±0.71 cm2, p <0.0001; 0.26±0.09 vs. 0.23±0.08 cm2, p= 0.04; 0.25±0.08 vs. 0.21±0.07, p= 0.01 cm², respectively).

Conclusions: Gender variations in aorta-iliofemoral artery areas persisted even after adjusting for BSA. This information may be useful when planning TAVR procedures.