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

Yang, Liu; Yang, Yi; Zhao, Jichun; Chen, Xiyang; Wang, Jiarong; Ma, Ying; Huang, Bin; Yuan, Ding; Du, Xinying

doi:10.1016/j.jvs.2019.06.105

Cited by 41 publications

(23 citation statements)

References 73 publications

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“…Furthermore, it has been well-documented that the outcomes of AAA are worse in female patients than in male patients. 6 Previous studies have demonstrated that female sex is independently associated with a faster rate of AAA growth 23 and tends to rupture at a smaller aortic size. 24 Furthermore, some animal studies have demonstrated that estrogen may play a protective role in the development of AAAs, while testosterone has an adverse effect on wall stress.…”

Section: Discussionmentioning

confidence: 99%

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Influence of Sex on Outcomes After Thoracic Endovascular Repair for Type B Aortic Dissection

et al. 2021

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We aimed to investigate whether sex differences influence the clinical outcomes of patients who undergo thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD). We retrospectively analyzed a prospectively maintained single-center cohort of patients with TBAD who underwent TEVAR between January 2010 and June 2017. We evaluated the in-hospital and long-term mortality and composite end point. Of the 913 patients, 793 (86.8%) were male and 120 (13.1%) were female. Compared to male patients, the female patients were older, more likely to have diabetes mellitus, but less likely to smoke or have hypertension. The proximal landing zone in 0 and 1 was higher in male patients ( P = .023), who were more likely to require an aortic arch bypass. Endoleak, delirium, and ICU stay after stent-graft implantation were also more frequent in men. Sex factor was not associated with in-hospital or long-term mortality or the composite end point in the multivariable regression analyses and Cox regression model. The mean estimated survival time was similar between males and females (2462.9 ± 141.2 vs 2804.1 ± 117.4 days, P = .167) in the propensity score–matched cohort. Despite distinct characteristics between sex, there was no sex-related difference in long-term clinical outcomes after TEVAR for TBAD.

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Section: Discussionmentioning

confidence: 99%

“…Aortic dissection (AD) affects 1.5-to 6-folds more men than women. [1][2][3] Although the sex differences in presentation and outcomes were well known in coronary artery disease 4,5 and abdominal aortic aneurysms (AAA), 6,7 only a few studies have focused on them in the context of AD.…”

Section: Introductionmentioning

confidence: 99%

Influence of Sex on Outcomes After Thoracic Endovascular Repair for Type B Aortic Dissection

et al. 2021

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“…A recent meta-analysis has confirmed significantly higher 30 day mortality in women following EVAR. 13 The outcomes for intact AAA repair in patients over eighty reported in this study were significantly worse overall and particularly for mortality after OSR at 9.3%. Although peri-operative mortality for EVAR was lower at 1.4%, nearly half of all EVAR deaths in this study occurred in this group.…”

Section: Discussionmentioning

confidence: 64%

Editor's Choice – Variation in Intact Abdominal Aortic Aneurysm Repair Outcomes by Country: Analysis of International Consortium of Vascular Registries 2010 – 2016

Boyle

Mao

Beck

et al. 2021

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDSIn this study of over 100 000 intact abdominal aortic aneurysm repairs, an increase in the proportion of patients undergoing endovascular aneurysm repair (EVAR) over time has been demonstrated. Peri-operative mortality rates are falling for both EVAR and open surgical repair. Outcomes however are poorer in women and octogenarians, and future efforts should be focused on improving outcomes for these patients.Objective: Outcomes for intact abdominal aortic aneurysm (AAA) repair vary over time and by healthcare system, country, and surgeon. The aim of this study was to analyse peri-operative mortality for intact AAA repair in 11 countries over time and compare outcomes by gender, age, and geographical location. Methods: Prospective data on primary repair of intact AAA were collected from 11 countries through the International Consortium of Vascular Registries (ICVR) and analysed for two time periods, 2010 e 2013 and 2014 e 2016. The primary outcome was peri-operative mortality after endovascular aneurysm repair (EVAR) and open surgical repair (OSR). Multivariable logistic regression models were used to adjust for differences in patient characteristics. Results: A total of 103 715 patients were included. The percentage of patients undergoing EVAR increased from 63.6% to 71.2% (p < .001) over the study period. This proportion varied by country from 35% in Hungary to 81% in the United States. Overall peri-operative mortality decreased from 2.1% to 1.6 % (p < .001). Mortality also declined significantly over time for both OSR 4.2% to 3.6 % (p ¼ .002) and EVAR 1.0% to 0.7% (p ¼ .002). Mortality was significantly higher for female than male patients (3.0% vs. 1.6% p < .001). The percentage of patients > 80 years old undergoing AAA repair remained constant at 23.6% (p ¼ .91). Peri-operative mortality was higher for patients > 80 years than for those < 80 years old (2.7% vs. 1.6% p < .001). Fortysix per cent (n ¼ 275) of all EVAR deaths occurred in the over 80s. Conclusion:The proportion of AAA repairs performed using EVAR has increased over time. Peri-operative mortality continues to decline for both OSR and EVAR. Outcomes however were significantly worse for both women and those aged over 80, so efforts should be focused on these patient groups to further reduce elective AAA mortality rates.

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“…Juxtarenale AAA waren wie in der vorliegenden Untersuchung als solche definiert, wenn die Aortenklemme wenigstens oberhalb der ersten Nierenarterie platziert wurde. Das Krankenhausfallvolumen an juxtarenalen AAA wurde in niedrig (0-<4), mittel (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) und hoch (>14 Fälle/Jahr) eingeteilt. In dieser Erhebung war ein geringes Fallvolumen an juxtarenalen AAA mit einer höheren Kliniksterblichkeit assoziiert, mit einer Klinikletalität von 9,0 %, 4,9 % und 3,9 %.…”

Section: Diskussionunclassified

Offene und endovaskuläre Versorgung des infrarenalen vs. juxtarenalen Bauchaortenaneurysmas

et al. 2020

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Zusammenfassung Hintergrund und Zielsetzung Die vorliegende Untersuchung geht der Frage nach, wie sich die perioperativen Ergebnisse bei elektiver Versorgung juxtarenaler abdomineller Aortenaneurysmen (AAA) von denen bei Versorgung infrarenaler AAA unterscheiden. Material und Methoden Datenbasis ist das AAA-Register des Deutschen Instituts für Gefäßmedizinische Gesundheitsforschung (DIGG) der Deutschen Gesellschaft für Gefäßchirurgie und Gefäßmedizin (DGG) der Jahre 2013–2017 mit insgesamt 18.629 Patienten, 17.026 (91,4 %) mit infrarenalem und 1603 (8,6 %) mit juxtarenalem AAA. Bei den infrarenalen AAA wurden 80,5 % (n = 13.707) endovaskulär (EVAR) und 3319 (19,5 %) offen (OAR) versorgt, bei den juxtarenalen waren es 786 Patienten mit EVAR (49,0 %) und 817 (51,0 %) mit OAR. Ergebnisse Sowohl bei OAR als auch bei EVAR waren Patienten mit juxtarenalen AAA in ihren Ausgangsbedingungen nicht mit Patienten mit infrarenalen AAA vergleichbar. Der Frauenanteil war bei juxtarenalen AAA signifikant höher (bei EVAR 16,9 % vs. 13,1 %, bei OAR 18,6 % vs. 16,0 %) und der Aneurysmadurchmesser war signifikant größer (bei EVAR 57,8 vs. 54,3 mm, bei OAR 59,0 vs. 56,3 mm). Patienten mit juxtarenalem AAA zeigten signifikant häufiger als Patienten mit infrarenalem AAA bereits präoperativ eine eingeschränkte Nierenfunktion (12,5 % vs. 9,7 % bei EVAR, 14,4 % vs. 9,4 % bei OAR). Die Klinikletalität betrug bei EVAR 1,0 % (infrarenale AAA) vs. 5,7 % (juxtarenale AAA) (p = 0,000), bei OAR 4,2 % (infrarenale AAA) vs. 7,7 % (juxtarenale AAA) (p = 0,000). Zu einer postoperativen Verschlechterung der Nierenfunktion kam es bei EVAR in 2,0 % der Fälle mit infrarenalen AAA vs. 12,2 % bei juxtarenalen AAA (p = 0,000), bei OAR in 7,9 % vs. 19,5 % (p = 0,000). Schlussfolgerungen Im vorliegenden Krankengut waren die Raten an postoperativen Komplikationen sowie die postoperative Sterblichkeit bei Versorgung juxtarenaler AAA signifikant höher als bei Versorgung infrarenaler AAA, das galt sowohl für EVAR als auch für OAR. Inwieweit dies an den ungünstigeren Ausgangsbedingungen bei Patienten mit juxtarenalen AAA lag und welche Rolle die gewählte Operationstechnik dabei spielte, sollte in weiteren Erhebungen überprüft werden.

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

Cited by 41 publications

References 73 publications

Influence of Sex on Outcomes After Thoracic Endovascular Repair for Type B Aortic Dissection

Influence of Sex on Outcomes After Thoracic Endovascular Repair for Type B Aortic Dissection

Editor's Choice – Variation in Intact Abdominal Aortic Aneurysm Repair Outcomes by Country: Analysis of International Consortium of Vascular Registries 2010 – 2016

Offene und endovaskuläre Versorgung des infrarenalen vs. juxtarenalen Bauchaortenaneurysmas

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