The Impact of Gender on Outcome of Endovascular Treatment of Thoraco-Abdominal Aortic Aneurysm

Abstract

Introduction - Female gender is associated with worse outcome in open as well in endovascular Aortic Aneurysm Repair. Few data are available on the influence of gender on endovascular treatment of thoraco-abdominal aortic aneurysm (TAAA) outcome. The aim of this study was to evaluate the effect of gender on outcome after TAAA endovascular repair using fenestrated and branched endograft (F/B-EVAR). Methods - Between 2010 and 2016, all patients undergoing F/B-EVAR for TAAA were prospectively collected and retrospectively analysed. Preoperative, procedural and postoperative data were assessed. Technical Success (TS), intraoperative adjunctive procedure, intraoperative and perioperative complications, 30d-mortality, freedom from re-interventions (FFR) and survival (S) were evaluated. FFR and S were estimated by Kaplan Meyer analysis. Results of female and male patients were compared by Fisher’s exact and log rank tests. Results - Seventy-three patients (male:57 [78%], female:16 [22%]) underwent F/B-EVAR for TAAA (Crawford type I-II-III:35; Crawford IV:38), using custom-made and off-the-shelf endograft. Median age was 73 ± 7 years. There were no differences in female and male comorbidities except for coronary artery disease (12% vs 44%, p=.03), chronic renal failure (12% vs 49%, p=.01)and previous aortic surgery (31% vs 68%, p=.01). Female had more iliac-femoral adjunctive procedures then men (50% vs 21%, p=.03) and a higher rate of intraoperative iliac-femoral complications (19% vs 2%, p=.03). Overall TS was 90.4% (female: 81%, male: 93%, p=.17). There were no differences in intraoperative and 30d-mortality between female and male (0% vs 0% and 13% vs 5%, p=.3, respectively). Female had similar renal (25% vs 16%, p=.46), cardiac (12% vs 7%, p=.60) and femoral access (19% vs 9%, p=.36) perioperative complications while had higher rate of perioperative respiratory (19% vs 3%, p=.05) complications then male. There were no significant differences in overall intensive care unit (female:20 ± 15 days, male:19 ± 25 days, p=.47) and hospital stay (female:5 ± 3 days, male:4 ± 3 days, p=0.99) between two groups. Overall survival at 6, 12 and 24 months was 89% 84% and 70%, respectively without difference between female and male (87%, 87% and 87% vs 90%, 81% and 58%; p: .95). Overall FFR at 6, 12 and 24 months was 89% 88% and 88%, respectively without difference between female and male (76%, 76% and 76% vs 94%, 87% and 87%; p: .26). Conclusion - Gender did not significantly affect F/B-EVAR outcome in TAAA, however procedures were affected by a higher rate of intraoperative iliac-femoral complications and iliac-femoral adjunctive procedures in female. Moreover female had higher risk for respiratory perioperative complications. Accurate preoperative evaluation of the iliac-femoral axis should be recommended in female in order to minimize and overcome intraoperative and perioperative complication.