Sex-dependent outcomes following elective endovascular aortic repair

Connie Truong; Nathan W Kugler; Peter J Rossi; Parag J Patel; Robert A Hieb; Kellie R Brown; Brian D Lewis; Gary Seabrook; Cheong J Lee

doi:10.1016/j.jss.2018.03.015

Sex-dependent outcomes following elective endovascular aortic repair

J Surg Res. 2018 Sep:229:177-185. doi: 10.1016/j.jss.2018.03.015. Epub 2018 Apr 30.

Authors

Connie Truong¹, Nathan W Kugler¹, Peter J Rossi¹, Parag J Patel², Robert A Hieb², Kellie R Brown¹, Brian D Lewis¹, Gary Seabrook¹, Cheong J Lee³

Affiliations

¹ Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
² Division of Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin.
³ Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin. Electronic address: cjlee@mcw.edu.

PMID: 29936987
DOI: 10.1016/j.jss.2018.03.015

Abstract

Background: Evidence has shown that women derive less benefit from endovascular aortic repair (EVAR) in large part due to more challenging aortoiliac anatomy. This study sought to examine whether sex-dependent outcomes exist following elective EVAR cases.

Methods: An institutional retrospective review was performed on patients who underwent elective EVAR procedures between 2008 and 2014. Outcome data collected included procedural and hospital morbidity, mortality, and overall EVAR durability based on the incidence of unplanned graft-related secondary interventions (SIs) (e.g., open conversion, proximal or distal extensions, and coil embolizations).

Results: One hundred eighty-one patients (150 men, 31 women) met the study inclusion criteria. Median follow-up was 40.3 mo. Women had more challenging anatomy compared to men including smaller overall iliac diameters (6.8 mm versus 8.0 mm, P < 0.001) and more severe iliac angulation (77% moderate to severe versus 44%, P < 0.001). Women had increased risk of postoperative complications compared to men (41.9% versus 11.3%, P = 0.003). There was no perioperative mortality in our series of elective EVAR cases. Median 5-y survival following EVAR was 64.4% for men and 76.3% for women (P = 0.599). Late SI rates following EVAR was 10.5% with 16 (10.7%) men and 3 (9.7%) women needing interventions (P = 0.870). Overall durability of EVAR extrapolated as time to SIs was 91% at 2 y and 85% at 5 y. Factors predisposing SIs were iliac tortuosity (P = 0.046), aortic neck angle (P = 0.022), and endoleak at the follow-up (P = 0.030).

Conclusions: In this study, immediate outcomes following EVAR were different between men and women, with women having increased rates of postoperative complications. Mortality and overall long-term durability of EVAR, however, were the same between sexes despite anatomical differences. EVAR durability was significantly dependent on the severity of iliac tortuosity, aortic neck angulation, and presence of endoleak at the follow-up.

Keywords: AAA; Abdominal Aortic Aneurysm; EVAR; Endovascular Aneurysm Repair; Sex Differences.

MeSH terms

Age Factors
Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal / mortality
Aortic Aneurysm, Abdominal / surgery*
Conversion to Open Surgery / statistics & numerical data
Elective Surgical Procedures / adverse effects*
Elective Surgical Procedures / methods
Endovascular Procedures / adverse effects*
Endovascular Procedures / methods
Female
Follow-Up Studies
Humans
Incidence
Length of Stay / statistics & numerical data
Male
Middle Aged
Postoperative Complications / epidemiology*
Postoperative Complications / etiology
Prospective Studies
Retrospective Studies
Risk Assessment
Risk Factors
Sex Factors
Time Factors
Treatment Outcome
Vascular Grafting / adverse effects*
Vascular Grafting / methods