Sex-related outcomes following endovascular repair of thoracoabdominal aortic aneurysm.

Abstract

Previous studies have suggested unique challenges in treating women with thoracoabdominal aortic aneurysms (TAAAs) compared with their male counterparts. We sought to examine the real-world outcomes of complex endovascular aneurysm repair (cEVAR) for TAAA in women and men. Patients undergoing cEVAR for type I to IV TAAAs between 2014 and 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. One-year survival after cEVAR was compared between women and men using the long-term follow-up data from the Vascular Quality Initiative. A total of 1128 patients underwent cEVAR for type I to IV TAAAs during the study period, of whom 417 (37%) were females. Women had more extensive aneurysms (84.7% vs 72.4% type I-III TAAA; P < .001) and were more likely to present with symptomatic aneurysm (26.1% vs 18.4%; P = .002) compared with men. Women were less likely to be on secondary cardiovascular preventative medications, including aspirin (59.4% vs 67.4%; P = .019) and statins (65.1% vs 73.1%; P = .012), more likely to be current smokers (36.1% vs 30.7%; P = .052), and treated at higher maximum diameter threshold (7.7 mm vs 4.6 mm above the recommended repair size; P < .001). Although there were no differences in operative time, women were more likely to have undergone a staged repair (22.3% vs 16.6%; P = .018) and have complicated iliofemoral access (19.2% vs 10.3%; P < .001) with a higher incidence of access complications (8.9% vs 5.2%; P = .016) compared with men. Thirty-day rates of mortality (11.8% vs 6.6%; P = .003) and overall complications (35.7% vs 25.7%; P < .001), including permanent spinal cord ischemia (5.5% vs 2.8%; P = .022) primarily among patients with type II TAAAs (7.8 vs 3.0%; P = .025), were all higher for women compared with men. One-year survival after cEVAR for TAAAs was significantly lower for women compared with men (74 vs 82%; P = .001), driven by the higher 30-day mortality rate in women. Female sex was an independent risk factor for both 30-day and 1-year mortality. This study demonstrated that women had higher 30-day morbidity and mortality and lower 1-year survival rates after cEVAR for type I to IV TAAAs compared with men. There were significant differences in presentation, anatomical features, and implementations of secondary cardiovascular preventative management, all likely affecting the differences in outcomes between women and men. Future studies are warranted to better understand these differences and optimize sex-specific approaches to management of TAAAs in women.