Faculty Collaboration Database

Sex-dependent outcomes following elective endovascular aortic repair. J Surg Res 2018 Sep;229:177-185

Date

06/26/2018

Pubmed ID

29936987

DOI

10.1016/j.jss.2018.03.015

Scopus ID

2-s2.0-85046115851 (requires institutional sign-in at Scopus site)   17 Citations

Abstract

BACKGROUND: Evidence has shown that women derive less benefit from endovascular aortic repair (EVAR) in large part due to more challenging aortoiliac anatomy. This study sought to examine whether sex-dependent outcomes exist following elective EVAR cases.

METHODS: An institutional retrospective review was performed on patients who underwent elective EVAR procedures between 2008 and 2014. Outcome data collected included procedural and hospital morbidity, mortality, and overall EVAR durability based on the incidence of unplanned graft-related secondary interventions (SIs) (e.g., open conversion, proximal or distal extensions, and coil embolizations).

RESULTS: One hundred eighty-one patients (150 men, 31 women) met the study inclusion criteria. Median follow-up was 40.3 mo. Women had more challenging anatomy compared to men including smaller overall iliac diameters (6.8 mm versus 8.0 mm, P < 0.001) and more severe iliac angulation (77% moderate to severe versus 44%, P < 0.001). Women had increased risk of postoperative complications compared to men (41.9% versus 11.3%, P = 0.003). There was no perioperative mortality in our series of elective EVAR cases. Median 5-y survival following EVAR was 64.4% for men and 76.3% for women (P = 0.599). Late SI rates following EVAR was 10.5% with 16 (10.7%) men and 3 (9.7%) women needing interventions (P = 0.870). Overall durability of EVAR extrapolated as time to SIs was 91% at 2 y and 85% at 5 y. Factors predisposing SIs were iliac tortuosity (P = 0.046), aortic neck angle (P = 0.022), and endoleak at the follow-up (P = 0.030).

CONCLUSIONS: In this study, immediate outcomes following EVAR were different between men and women, with women having increased rates of postoperative complications. Mortality and overall long-term durability of EVAR, however, were the same between sexes despite anatomical differences. EVAR durability was significantly dependent on the severity of iliac tortuosity, aortic neck angulation, and presence of endoleak at the follow-up.

Author List

Truong C, Kugler NW, Rossi PJ, Patel PJ, Hieb RA, Brown KR, Lewis BD, Seabrook G, Lee CJ

Authors

Kellie R. Brown MD Professor in the Surgery department at Medical College of Wisconsin
Robert A. Hieb MD, RVT, FSIR Professor in the Radiology department at Medical College of Wisconsin
Nathan W. Kugler MD Assistant Professor in the Surgery department at Medical College of Wisconsin
Brian D. Lewis MD Professor in the Surgery department at Medical College of Wisconsin
Parag J. Patel MD, MS, FSIR Vice Chair, Professor in the Radiology department at Medical College of Wisconsin
Peter J. Rossi MD Chief, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Age Factors
Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal
Conversion to Open Surgery
Elective Surgical Procedures
Endovascular Procedures
Female
Follow-Up Studies
Humans
Incidence
Length of Stay
Male
Middle Aged
Postoperative Complications
Prospective Studies
Retrospective Studies
Risk Assessment
Risk Factors
Sex Factors
Time Factors
Treatment Outcome
Vascular Grafting