Gender Differences in Endovascular Aneurysm Repair | Journal Scan

Study Questions:

What is the relationship between gender and outcome after endovascular repair (EVAR) for aortic aneurysm?


Between 1992 and 2012, 1,380 elective infrarenal abdominal aortic aneurysms (AAAs) were repaired using endovascular endografts. Anatomic characteristics and outcomes were stratified by gender.


Of the 1,380 EVAR procedures, 214 (15.5%) were performed in women. Women were older than men (77.8 vs. 74.5 years, p < 0.001) and had less cardiac disease at the time of repair. AAA length was shorter in women versus men (19.8 ± 12.9 vs. 26.3 ± 14.7 mm, p < 0.001), and with a more angulated aortic neck (38.8° ± 16.1° vs. 31.1° ± 14.7°, p < 0.001). Women had more arterial reconstructions, more perioperative complications (16.9% vs. 9.1%, p < 0.001), and more in-hospital days (4.1 vs. 3.4, p = 0.029) as compared to men. Perioperative mortality was equivalent (2% vs. 2.3%, p = 0.73) in women versus men. During a mean follow-up of 30.9 months, women and men experienced equivalent aneurysm-related deaths and overall survival. Women were more likely to develop an endoleak, but with no difference in the rate of arterial re-intervention.


The authors concluded that female gender is associated with more periprocedural complications and arterial procedures, but no long-term re-intervention risk or survival difference.


Despite the limitations of an observational, mostly single-center cohort design, this study highlights key differences between women and men treated with EVAR for AAA. Different anatomical findings between men and women with AAA may impact the type of stent graft selected. Patients should be advised that while women might be at risk for more periprocedural complications, the long-term durability and safety of EVAR are equivalent to the outcomes seen in men.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Vascular Medicine, Aortic Surgery, Interventions and Vascular Medicine

Keywords: Aorta, Aortic Aneurysm, Abdominal, Aortic Aneurysm, Cardiac Surgical Procedures, Endoleak, Endovascular Procedures, Female, Follow-Up Studies, Heart Diseases, Male, Mortality, Perioperative Period, Stents

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