Sex-based outcomes after endovascular repair of thoracic aortic aneurysms

Abstract

Unlike with abdominal aortic aneurysms (AAA), women appear to have an almost comparable incidence as men for thoracic aortic aneurysms (TAA). However, the extent to which a patient's sex influences endograft treatment of TAA has not been reported. The current study analyzes the influence of sex on the endovascular management of TAAs. A total of 421 patients (265 men and 156 women) were identified as part of the TAG (W. L. Gore and Associates, Flagstaff, Ariz) thoracic stent graft trials. Preoperative risk factors, intraoperative events, and 365-day follow-up data were analyzed. Among 18 different preoperative risk factors evaluated, women were less likely to have prior vascular procedures (38.9% vs 55.3%; P = .004). A trend was noted toward lower rates of coronary artery disease (41.3% vs 51.2%; P = .09) and smoking (77.8% vs 85.6%; P = .08). Women were also more likely to be nonwhite (81.4% vs 87.9%; P = .007). Women had a smaller mean external iliac vessel diameter (7.1 vs 9.0 mm; P < .001), resulting in 24.4% vs 6.0% conduit use (P < .001) for device delivery. Local access site complications were significantly higher in women (14.1% vs 4.5%; P < .001). No difference was noted between sexes in the technical success rate (device delivery and successful aneurysm exclusion) or the major adverse event rate at 30 days (26.3% vs 20.4%; P = .18). The overall length of stay was 5.5 ± 6.2 days for female patients vs 4.8 ± 13.0 days (P < .001). No sex-related difference was noted in endoleak rate, aneurysm rupture, prosthetic migration, or aneurysm diameter change at 365 days. No significant differences in major outcomes were noted between men and women treated with endovascular repair of TAA at 1 month and 1 year. Women have more vascular complications, which are associated with smaller access vessels. A lower threshold for using conduits in women may be a more prudent approach.