Female Gender Is Associated With Worse Outcomes Following Complex Fenestrated Or Branched Endovascular Aortic Repair

Abstract

<h3>INTRODUCTION AND OBJECTIVES</h3> Gender discrepancies during aortic repair are noted to disproportionally affect females. Recent examination of complex fenestrated and branched endovascular aneurysm repair (FBEVAR) at high-volume centers noted equivalent mortality among genders following repair. Whether similar results extend to real-world practice is unknown. <h3>Methods</h3> Utilizing the Vascular Quality Initiative (VQI) database from 2012-2020, all juxtarenal and type IV aneurysms (sealing zones 5-8) who underwent elective FBEVAR were included. Urgent, symptomatic, ruptured and staged cases were excluded. Demographics, comorbid conditions and technical factors were compared between genders. Our outcomes included in-hospital mortality, any complications, and retreatments. Multivariable logistic regression was used to adjust for patient and procedural factors. <h3>RESULTS</h3> There were 1547 males (77.5%) and 449 females (22.5%) included in our analysis. There were noted differences in pre-operative co-morbid conditions, medical optimization, and technical aspects of the procedure (Table 1). However, no difference was noted in proximal or distal sealing stent, number of fenestrations, or immediate post-procedure endoleak. Overall women had a higher incidence of in-hospital mortality, 5.6% versus 1.9% in men (P<0.001). On multivariable logistic regression female gender was an independent predictor of increased complications (OR 1.672 95% CI: 1.202-2.324, P=0.002), retreatment (OR 2.765, 95% CI: 1.745-4.070, P<0.001), and mortality (OR 2.296, 95% CI: 1.301-4.053, P=0.004).Image, table 1Image, table 1 <h3>CONCLUSIONS</h3> Females undergoing FBEVAR had similar extent of disease, number of fenestrations, and incidence of immediate endoleak but worse COPD and lower rates of optimal medical therapy. Despite adjustment for patient and procedural factors, female sex remained associated with worse outcomes. These data strongly support the need to incorporate the increased risks of repair for females when contemplating FBEVAR.