Gender and Outcomes After Fenestrated Endovascular Repair
What is the effect of gender on perioperative outcomes after fenestrated endovascular aortic aneurysm repair (FEVAR) for complex abdominal aortic aneurysms using premanufactured devices?
During a 2-year period, 79 patients (63 men [80%] and 16 women [20%]) underwent FEVAR using Zenith Fenestrated AAA Endovascular Grafts, investigational Zenith pivot branch (p-branch) devices, and fenestrated custom-made devices. A single-institutional study was performed to evaluate postoperative outcomes after FEVAR. The χ2, Fisher’s, and nonparametric tests were used for bivariate analysis. The relationship of gender with mortality, morbidity, and each of the six complication subgroups was evaluated further using multivariate logistic regressions to adjust for risk and procedural variables.
Median age was 73 years (interquartile range [IQR], 68-79 years). The median number of fenestrations was three. There was no difference in aneurysm anatomic location, size, or number of fenestrations between patients in either group. Women were more likely to undergo endoconduits at the access site before the target procedure (19% vs. 2%; p = 0.02). The overall postoperative complication rate was similar among females and males (31% vs. 33%; p > 0.5). However, women experienced longer times in the intensive care unit (median, 3 days [IQR, 2-5] vs. 2 [IQR, 1-3]; p = 0.05) and longer durations of hospital stay (median, 4.5 days [IQR, 3-6.5] vs. 3 [IQR, 2-4]; p < 0.01). Similarly, the rate of reinterventions was higher among women (25% vs. 5%; p = 0.02). For renal adverse events, there was a trend for a higher rate of renal function deterioration based on creatinine levels among women, when compared with men (18% vs. 5%; p = 0.09). Multivariate analysis showed that female gender was associated with an eight-fold increased risk of renal function deterioration (odds ratio, 8.1; 95% confidence interval, 6.1-10.8). Female gender was also identified as an independent factor for reinterventions at 30 days (odds ratio, 7.4; 95% confidence interval, 6.7-8.1).
The authors concluded that women are at greater risk for more severe renal function deterioration, early reinterventions, and longer durations of hospital and intensive care unit stay after FEVAR.
This single-center, observational, retrospective study reports that the 30-day morbidity as defined by the rate of major adverse events (all-cause mortality, bowel ischemia, myocardial infarction, paraplegia, respiratory failure, stroke, and renal failure requiring dialysis) in patients undergoing FEVAR is similar in women and men. However, female patients have a higher rate of renal function deterioration when compared with males, with increased risk of early reinterventions (30 days) and longer hospital and intensive care unit durations of stay. After multivariate analysis, gender was an independent predictor of renal function impairment. While postoperative outcomes may be influenced by gender after FEVAR, it appears that overall, FEVAR is a safe and effective procedure for patients at high and standard risk for open repair that are not eligible for standard EVAR.
Keywords: Aortic Aneurysm, Abdominal, Cardiac Surgical Procedures, Creatinine, Endovascular Procedures, Female, Intensive Care Units, Length of Stay, Myocardial Infarction, Paraplegia, Postoperative Complications, Renal Dialysis, Renal Insufficiency, Respiratory Insufficiency, Stroke, Vascular Diseases
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