Abstract
IntroductionWomen are less likely to develop infrarenal abdominal aortic aneurysm; however, when they do, it is almost always associated with challenging anatomy, more rapid aneurysmal growth rate and earlier rupture. Women generally have poorer outcomes following open aneurysm repair; and in this respect, the present study aims to evaluate if it is so after endovascular repair.MethodsA retrospective analysis of our database was performed for patients underwent endovascular aneurysm repair (EVAR) between January 2013–March 2020. 249 elective EVAR patients were evaluated. Patients were categorized according to gender and 26 patients (10.4%) were female. Demographics and pre-peri-postoperative findings were compared. Propensity score matching (ratio 1:1) was performed to reduce selection bias.ResultsIn the overall unmatched cohort, female population had more diabetes mellitus (p = 0.016) and hypertension (p = 0.005). However, coronary artery disease (p = 0.005) and coronary artery bypass grafting (p = 0.006) were more in male gender. Non-IFU implantation was higher in female group (38.5% vs. 11.5%, p = 0.025). After propensity matching, even though it was not statistically significant, early mortality for female gender was higher when compared to male gender (7.7% and 0%, respectively, p = 0.490). In the follow-up period, no difference in all-cause mortality, secondary interventions or complications have been observed between the genders.ConclusionChallenging anatomy and subsequently treated patients outside IFU may be the reasons for higher morbidity and mortality in women. However, despite these factors female and male patients revealed equivalent early and late results.
Highlights
Women are less likely to develop infrarenal abdominal aortic aneurysm; when they do, it is almost always associated with challenging anatomy, more rapid aneurysmal growth rate and earlier rupture
This study aims to evaluate the outcomes of elective endovascular aneurysm repair (EVAR) procedures in women with infrarenal Abdominal aortic aneurysm (AAA) and to compare with male patients in our EVAR experience
Outcomes and follow‐up Regarding early postoperative data, intensive care unit (ICU) stay was significantly higher in female group for unmatched groups (8 h vs. 4 h, p = 0.002)
Summary
Women are less likely to develop infrarenal abdominal aortic aneurysm; when they do, it is almost always associated with challenging anatomy, more rapid aneurysmal growth rate and earlier rupture. Abdominal aortic aneurysm (AAA) prevalence according to the screening programs over 65 years old men is around 1.3–3.3% [1]. A recent systematic review of publications between 2000 and 2015 indicates that the pooled prevalence of AAA in women over 60 years was 0.7% [1, 3]. Even though the incidence and prevalence of AAA in female gender is only one quarter of males, the Society of Vascular Surgeons recommends population screening for AAA for men and women over 65 years at the current guideline for the first time, ESVS does not [1, 4]. Women usually present with smaller aneurysms while having greater growth rates and there are differences between genders at every stage of the disease, from epidemiology to pathophysiology and from morbidity to mortality [5]
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