Endovascular Abdominal Aneurysm Repair in Women: What are the Differences Between the Genders?

Abstract

INTRODUCTION:Abdominal aortic aneurysm has a lower incidence in the female population, but a higher complication rate. It was been hypothesized that some anatomical differences of abdominal aortic aneurysm in women could be responsible for that. We proposed to analyze our data to understand the differences in the clinical and anatomical characteristics and the outcomes of patients undergoing endovascular aneurysm repair, according to gender.METHODS:A retrospective analysis of patients undergoing endovascular aneurysm repair between 2001-2013 was performed. Patients were divided according gender and evaluated regarding age, atherosclerotic risk factors, aneurysm anatomic features, endograft type, anesthesic risk classification, length of stay, reinterventions and mortality. Two statistical studies were performed, first comparing women and men (Group A) and a second one comparing women and men, adjusted by age (Group B).RESULTS:Of the 171 patients, only 5.8% (n=10) were females. Women were older (P<0.05) and the number of women with no atherosclerotic risk factor was significantly higher. The comparison adjusted by age revealed women with statistically less smoking history, less cerebrovascular disease and ischemic heart disease. Women had a trend to more complex anatomy, with more iliac intern artery aneurysms, larger aneurysm diameter and neck angulations statistically more elevated. No other variables were statistically different between age groups, neither reintervention nor mortality rates.CONCLUSION:Our study showed a clear difference in the clinical characteristics of women. The female population was statistically older, and when compared with men adjusted by age, had less atherosclerotic risk factors and less target organ disease. Women showed a more complex anatomy but with the same outcomes.

Systematic review and meta-analysis of sex differences in outcomes after endovascular aneurysm repair for infrarenal abdominal aortic aneurysm

“…In total, 3392 publications were retrieved from the initial systematic literature search (Supplementary Table I, online only) and 21 publications were obtained by the manually computer-aided bibliographic search from the earlier review. After removing duplicates, screening titles/abstracts and reviewing full-texts, 32 studies met the selection criteria and were included in this meta-analysis, 7,8,[13][14][15][16][17][18][19][20][21][22][23][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] three studies of which were verified by obtaining data through contact with the authors. 29,32,36 Four studies reported independent data for both intact AAA and ruptured AAA, which were separated into two different cohorts.…”

“…29,32,36 Four studies reported independent data for both intact AAA and ruptured AAA, which were separated into two different cohorts. 30,33,35,39 Finally, we analyzed a total of 36 cohorts (Fig 1), in which 25 cohorts investigated intact AAA, 7,8,[13][14][15][16][17][18][20][21][22][23][28][29][30][31][33][34][35][39][40][41][42]44,45 7 investigated ruptured AAA, 19,30,32,33,35,36,39 and 4 investigated indeterminate AAA. 37,38,43,46 All cohorts were from retrospective studies without high risk bias assessed by Newcastle-Ottawa Scale (Supplementary Table II, online only), 13 cohorts of which were multiple-center studies.…”

“…17,18 Recently, several nationwide and multicenter studies investigating the sex differences in outcomes after EVAR have been published. 8,14,15,[17][18][19][20][21][22][23] Consequently, we performed this comprehensive systematic review and meta-analysis of current evidence, aiming to compare both short-term and long-term outcomes between women and men after EVAR for infrarenal AAA to help vascular surgeons or physicians make better management plans for women.…”

Differences in Comorbidities Between Women and Men Treated with Elective Repair for Abdominal Aortic Aneurysms: A Systematic Review and Meta-Analysis

“…(60) It has been reported that women have more complex aneurysms with unfavourable neck anatomy than men, which is reflected in the observation that women are less often eligible for EVAR. (7,41,61) Compared with men, women have higher perioperative mortality after complex EVAR, but not after complex OSR. (60) The impact of a potentially more hostile aneurysm neck morphology in women on mortality could not be accounted for and this limits the interpretation of the role of comorbidity in the mortality disparity.…”

Women undergoing endovascular thoracoabdominal aortic aneurysm repair differ significantly from their male counterparts preoperatively and postoperatively

“…7 Indeed, although female patients undergoing EVAR tend to be older, they are also healthier, having fewer diagnosed instances of heart disease, diabetes, concurrent smoking, chronic obstructive pulmonary disease (COPD), and chronic renal dysfunction. 8 There have been several studies where controlling for age, urgency at presentation, comorbidities, and risk factors has resulted in equipoise of perioperative and 1-year mortality. 6 There is interplay between a patient's comorbidities and their aneurysm anatomy, which ultimately determines long-term outcome: successful aneurysm exclusion, prevention of rupture, aneurysm-related mortality, and overall survival.…”