Women derive less benefit from elective endovascular aneurysm repair than men

Mehta, Manish; Byrne, William J.; Robinson, Handel; Roddy, Sean P.; Paty, Philip S.K.; Kreienberg, Paul B.; Feustel, Paul J.; Darling, R. Clement

doi:10.1016/j.jvs.2011.11.047

Cited by 112 publications

(108 citation statements)

References 21 publications

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“…Some of the reduction in operative mortality in women might have come at the expense of the high proportion of women (a third) who are assigned to a non-intervention policy; although, the literature on non-intervention policy remains sparse. 32 Nevidomskyte et al (2016) 25 Chung et al (2015) 31 Lo et al (2013) 27 Mani et al (2013) 28 Mehta et al (2012) 29 Powell et al (2017) 5 …”

Section: Discussionmentioning

confidence: 99%

“…[25][26][27][28][29][30][31][32] For one study 31 reporting from 1992 to 2012, the 30-day operative mortality data for the late era (2003-12) were obtained from the corresponding author. Similarly, the data for 30-day mortality for the time period 2006-10 in the Swedish study 28 5 was identified and we excluded the few patients with repairs before 2000.…”

Section: Studiesmentioning

confidence: 99%

“…Three population-based studies 28,30,32 were done in Sweden (765 women), the USA (5421 women), and the UK (2304 women). Other, mostly smaller, studies, [25][26][27]29,31 based on either single centre or voluntary registries, were all from the USA and included 2438 women. Individual patient data meta-analysis 5 of four prospective randomised controlled trials contributed data for 148 women.…”

Section: Studiesmentioning

confidence: 99%

“…Lowry et al (2016) 32 Nevidomskyte et al (2016) 25 Chung et al (2015) 31 Lo et al (2013) 27 Mani et al (2013) 28 Mehta et al (2012) 29 Powell et al (2017) 5 Schermerhorn et al (2012) 32 Nevidomskyte et al (2016) 25 Chung et al (2015) 31 Lo et al (2013) 27 Mani et al (2013) 28 Mehta et al (2012) 29 Powell et al (2017) 5 Schermerhorn et al (2012) Surgical registries and national databases do not record or report the numbers of patients with abdominal aortic aneurysm who either are morphologically suitable for EVAR or denied elective repair. The only nonintervention data identified came from four single centres in the UK, with decisions about repair being made at a multidisciplinary team meeting: presumably the women not offered repair had extensive comorbidities and had a high risk of early postoperative death.…”

Section: Menmentioning

confidence: 99%

“…Nevidomskyte et al (2016) 25 Lo et al (2013) 27 Mani et al (2013) 28 Ramanan et al (2013) 26 Mehta et al (2012) 29 Powell et al (2017) 5 …”

Section: Studiesmentioning

confidence: 99%

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Morphological suitability for endovascular repair, non-intervention rates, and operative mortality in women and men assessed for intact abdominal aortic aneurysm repair: systematic reviews with meta-analysis

Ulug¹,

Sweeting²,

vonAllmen³

et al. 2017

Journal of Vascular Surgery

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1 ArticlesMorphological suitability for endovascular repair, non-intervention rates, and operative mortality in women and men assessed for intact abdominal aortic aneurysm repair: systematic reviews with meta-analysis Pinar Ulug, Michael J Sweeting, Regula S von Allmen, Simon G Thompson, Janet T Powell, on behalf of the SWAN collaborators* Summary Background Prognosis for women with abdominal aortic aneurysm might be worse than the prognosis for men. We aimed to systematically quantify the differences in outcomes between men and women being assessed for repair of intact abdominal aortic aneurysm using data from study periods after the year 2000.Methods In these systematic reviews and meta-analysis, we identified studies (randomised, cohort, or cross-sectional) by searching MEDLINE, Embase, CENTRAL, and grey literature published between Jan 1, 2005, and Sept 2, 2016, for two systematic reviews and Jan 1, 2009, and Sept 2, 2016, for one systematic review. Studies were included if they were of both men and women, with data presented for each sex separately, with abdominal aortic aneurysms being assessed for aneurysm repair by either endovascular repair (EVAR) or open repair. We conducted three reviews based on whether studies reported the proportion morphologically suitable (within manufacturers' instructions for use) for EVAR (EVAR suitability review), non-intervention rates (non-intervention review), and 30-day mortality (operative mortality review) after intact aneurysm repair. Studies had to include at least 20 women (for the EVAR suitability review), 20 women (for the non-intervention review), and 50 women (for the operative mortality review). Studies were excluded if they were review articles, editorials, letters, or case reports. For the operative review, studies were also excluded if they only provided hazard ratios or only reported in-hospital mortality. We assessed the quality of the studies using the NewcastleOttawa scoring system, and contacted authors for the provision of additional data if needed. We combined results across studies by random-effects meta-analysis. This study is registered with PROSPERO, number CRD42016043227.Findings Five studies assessed the morphological eligibility for EVAR (1507 men, 400 women). The overall pooled proportion of women eligible (34%) for EVAR was lower than it was in men (54%; odds ratio [OR] 0·44, 95% CI 0·32-0·62). Four single-centre studies reported non-intervention rates (1365 men, 247 women). The overall pooled non-intervention rates were higher in women (34%) than men (19%; OR 2·27, 95% CI 1·21-4·23). The review of 30-day mortality included nine studies (52 018 men, 11 076 women). The overall pooled estimate for EVAR was higher in women (2·3%) than in men (1·4%; OR 1·67, 95% CI 1·38-2·04). The overall estimate for open repair also was higher in women (5·4%) than in men (2·8%; OR 1·76, 95% CI 1·35-2·30).Interpretation Compared with men, a smaller proportion of women are eligible for EVAR, a higher proportion of women are not offered intervention, and operative...

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Section: Discussionmentioning

confidence: 99%

Section: Studiesmentioning

confidence: 99%

Section: Studiesmentioning

confidence: 99%

Section: Menmentioning

confidence: 99%

“…Nevidomskyte et al (2016) 25 Lo et al (2013) 27 Mani et al (2013) 28 Ramanan et al (2013) 26 Mehta et al (2012) 29 Powell et al (2017) 5 …”

Section: Studiesmentioning

confidence: 99%

See 3 more Smart Citations

Morphological suitability for endovascular repair, non-intervention rates, and operative mortality in women and men assessed for intact abdominal aortic aneurysm repair: systematic reviews with meta-analysis

Ulug¹,

Sweeting²,

vonAllmen³

et al. 2017

Journal of Vascular Surgery

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Surveillance Intervals for Small Abdominal Aortic Aneurysms

Bown

Sweeting²,

Brown

et al. 2013

JAMA

185

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Primary Care Screening for Abdominal Aortic Aneurysm

Guirguis-Blake

Beil

Senger

et al. 2019

JAMA

116

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IMPORTANCE Ruptured abdominal aortic aneurysms (AAAs) have mortality estimated at 81%. OBJECTIVE To systematically review the evidence on benefits and harms of AAA screening and small aneurysm treatment to inform the US Preventive Services Task Force. DATA SOURCES MEDLINE, PubMed (publisher supplied only), Database of Abstracts of Reviews of Effects, and Cochrane Central Register of Controlled Trials for relevant English-language studies published through September 2018. Surveillance continued through July 2019. STUDY SELECTION Trials of AAA screening benefits and harms; trials and cohort studies of small (3.0-5.4 cm) AAA treatment benefits and harms. DATA EXTRACTION AND SYNTHESIS Two investigators independently reviewed abstracts and full-text articles and extracted data. The Peto method was used to pool odds ratios (ORs) for AAA-related mortality, rupture, and operations; the DerSimonian and Laird random-effects model was used to pool calculated risk ratios for all-cause mortality. MAIN OUTCOMES AND MEASURES AAA and all-cause mortality; AAA rupture; treatment complications. RESULTS Fifty studies (N = 323 279) met inclusion criteria. Meta-analysis of population-based randomized clinical trials (RCTs) estimated that a screening invitation to men 65 years or older was associated with a reduction in AAA-related mortality over 12 to 15 years (OR, 0.65 [95% CI, 0.57-0.74]; 4 RCTs [n = 124 926]), AAA-related ruptures over 12 to 15 years (OR, 0.62 [95% CI, 0.55-0.70]; 4 RCTs [n = 124 929]), and emergency surgical procedures over 4 to 15 years (OR, 0.57 [95% CI, 0.48-0.68]; 5 RCTS [n = 175 085]). In contrast, no significant association with all-cause mortality benefit was seen at 12-to 15-year follow-up (relative risk, 0.99 [95% CI 0.98-1.00]; 4 RCTs [n = 124 929]). One-time screening was associated with significantly more procedures over 4 to 15 years in the invited group compared with the control group (OR, 1.44 [95% CI, 1.34-1.55]; 5 RCTs [n = 175 085]). Four trials (n = 3314) of small aneurysm surgical treatment demonstrated no significant difference in AAA-related mortality or all-cause mortality compared with surveillance over 1.7 to 12 years. These 4 early surgery trials showed a substantial increase in procedures in the early surgery group. For small aneurysm treatment, registry data (3 studies [n = 14 424]) showed that women had higher surgical complications and postoperative mortality compared with men. CONCLUSIONS AND RELEVANCE One-time AAA screening in men 65 years or older was associated with decreased AAA-related mortality and rupture rates but was not associated with all-cause mortality benefit. Higher rates of elective surgery but no long-term differences in quality of life resulted from screening.

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Women derive less benefit from elective endovascular aneurysm repair than men

Abstract: Mortality for females undergoing elective EVAR is significantly greater than for males. It is also more hazardous. Colon ischemia, native arterial rupture, and type 1 endoleaks are more frequent. Elective endovascular aneurysm repair benefits men more than women.

Cited by 112 publications

References 21 publications

Morphological suitability for endovascular repair, non-intervention rates, and operative mortality in women and men assessed for intact abdominal aortic aneurysm repair: systematic reviews with meta-analysis

Morphological suitability for endovascular repair, non-intervention rates, and operative mortality in women and men assessed for intact abdominal aortic aneurysm repair: systematic reviews with meta-analysis

Surveillance Intervals for Small Abdominal Aortic Aneurysms

Primary Care Screening for Abdominal Aortic Aneurysm

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