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Real-world Sex-related Outcomes following Complex Endovascular Repair for Thoracoabdominal Aortic Aneurysms
Jeanwan Kang
1, Cheng Zhang
1, Turna Mukherjee
2, Krystal Maloni
1, Sadia Ilyas
1, Javairiah Fatima
11MedStar Heart and Vascular Institute, Washington, DC;
2Northwell Health, Bay Shore, NY
BACKGROUND - Previous studies have suggested worse outcomes for women following thoracoabdominal aortic aneurysm (TAAA) treatment compared to their male counterparts. We sought to examine the real-world outcomes of complex endovascular repair (cEVAR) for TAAA between women and men.
METHODS - Patients undergoing cEVAR for type I-IV TAAAs between 2014-2020 were identified using the Vascular Quality Initiative database. Demographic, preoperative, and intraoperative variables, as well as postoperative outcomes were compared between women and men.
RESULTS - A total of 1128 patients underwent cEVAR for type I-IV TAAAs during the study period, of whom 417 (37%) were females. Women were slightly older (72.1 vs 70.8; P=0.037), had more extensive aneurysms, and higher prevalence of chronic obstructive pulmonary disease (44.6% vs 36.3%; P=0.006) but lower prevalence of coronary artery disease (20.4% vs 30.2%; P=<.001) and chronic kidney disease (4.9% vs 11.8%; P<0.001). Women were less likely to be on secondary cardiovascular preventative medications, including aspirin (59.4% vs 67.5%; 0.006) and statins (65.1% vs 73.3%; P=0.004), more likely to be current smokers (36.3% vs 30.7%; P=0.052), treated at higher maximum diameter threshold and more likely to present with symptomatic aneurysm (26.1% vs 18.4%; P=0.002) compared to men. While there were no differences in operative time or incidence of type I or III endoleaks at the conclusion of case, women were more likely to have undergone a staged repair (22.9% vs 16.9%; P=0.014) and have complicated iliofemoral access (20.9% vs 12.5%; P<.001) with higher incidence of access complications (8.9% vs 5.2%; P=0.016) compared to men. Thirty-day rate of mortality (11.8% vs 6.6%; P=0.003) and overall complication (35.8% vs 25.7%; P<.001), including permanent spinal cord ischemia (5.5% vs 2.8%; P=0.022), were all higher for women compared to men, as well as a trend towards higher 30-day reintervention rate (9.8% vs 6.7%; P=0.063) among women.
CONCLUSIONS - This study suggests that women with TAAAs are less likely to receive appropriate secondary cardiovascular preventative care, have more advanced aortic disease at the time of treatment, and are more likely to present with symptomatic status. Women undergoing cEVAR for TAAAs require more extensive treatment with significantly worse 30-day mortality and morbidity compared to men. Further studies are warranted to ensure optimal management of TAAAs for women.
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