Elective endovascular aneurysm repair benefits men more than women

A study published in the April issue of Journal of Vascular Surgery reports that women derive less benefit than men from elective endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAA's). The research was done at The Vascular Group, The Institute for Vascular Health and Disease, Albany Medical College, The Center for Vascular Awareness Inc., in Albany, NY.

Data was collected between 2002 and 2009 from 2,631 consecutive patients who had EVAR and open surgical repair (OSR) by The Vascular Group. Of these, there were 1,592 elective EVAR's (1,248 male, 344 female) and 106 emergent EVAR's for ruptured AAA's (73 male, 33 female). Elective OSR was performed in 788 patients (579 male, 209 females) and emergent OSR in 149 patients (73 male, 76 female).

"We analyzed the outcomes of all elective and emergent AAA's that underwent EVAR or OSR in women and compared results with those for men," said co-author Manish Mehta, MD, MPH. "The findings of our study indicated that the mortality for females undergoing elective EVAR was significantly greater than what was seen for males (3.2 percent for women, 0.96 percent for men). At presentation, women were also older and made up for a larger proportion of ruptured AAA patients than elective patients (33 percent vs. 23 percent)."

Women with elective EVAR had a greater incidence of intraoperative iliac artery or aortic neck rupture than men (4.1 percent vs. 1.2%), and required Palmaz stent s for type 1 endoleaks twice as frequently as men (16.1 percent vs. 8 percent). The perioperative complications were more frequently seen in women including leg ischemia mostly access related thromboembolic (3.5 percent vs. 0.6 percent), and colon ischemia requiring colectomy (0.9 percent vs. 0.2 percent). Women also had a greater mean intraoperative estimated blood loss (327 ml vs. 275 ml), and mean hospital length of stay (3.7 days vs. 2.2 days).

"Our study reflects the 'real world' clinical outcomes of in AAA patients with complex aortoiliac morphology and risk factors that undergo EVAR and OSR," added Dr. Mehta. "The fact that women tend to be older and more frequently present with ruptured AAA's suggests that women are less likely to undergo aneurysm evaluation than men. This delay in diagnosis might also reflect why women tend to have more complex aneurysm morphology that is less favorable for EVAR, they require more adjunctive and secondary procedures increasing their morbidity and mortality."

In contrast to elective EVAR, there were no significant gender differences for any of these outcome measures for emergent EVAR, or elective and emergent OSR. Overall outcomes favored EVAR over OSR in both men and women, but this difference was only statistically significant in men. "In comparing our study at Albany Medical Center to the published studies on the NSQIP (National Surgical Quality Improvement Program) database, it would appear that EVAR outcomes at large volume AAA centers might lower the mortality in men (0.96 percent in the Albany vascular group study vs. 2.1% in NSQIP database study), but not necessarily in women (3.2 percent in the Albany vascular group study vs. 3.4 percent in NSQIP database study). This further highlights the need for refinements in stent graft technology that would be better suited for women." 

Source Society for Vascular Surgery