Gender and Perioperative Outcomes Evaluated for FEVAR With Custom-Made and Off-the-Shelf Devices

November 30, 2016—A study was conducted to determine the effect of gender on perioperative outcomes after fenestrated endovascular aortic aneurysm repair (FEVAR) for complex abdominal aortic aneurysms (AAAs) using premanufactured devices. David Timaran, MD, et al published the findings in Journal of Vascular Surgery (2016;64:267–272).

The investigators concluded that FEVAR is a safe and effective procedure for patients at high and standard risk for open repair who are not eligible for standard endovascular repair. Additionally, the study showed that women are at greater risk for more severe renal function deterioration, early reinterventions, and longer durations of hospital and intensive care unit stay.

As summarized in Journal of Vascular Surgery, the study was composed of 79 patients (63 men [80%] and 16 women) who underwent FEVAR during a 2-year period using Zenith fenestrated AAA endovascular grafts (Cook Medical), investigational Zenith pivot branch (p-branch) devices (Cook Medical), and fenestrated custom-made devices.

The single-institutional study evaluated postoperative outcomes after FEVAR. Bivariate analysis was conducted using the χ2, Fisher's, and nonparametric tests. Logistic regression was used for multivariate analysis.

The median age was 73 years (interquartile range [IQR], 68–79 years). The median number of fenestrations was three. There was no difference in aneurysm anatomic location, size, or number of fenestrations between patients in either group. Women were more likely to undergo endoconduits at the access site before the target procedure (19% vs 2%; P = .02).

The investigators found that the overall postoperative complication rate was similar among women and men (31% vs 33%; P > .5). However, women experienced longer times in the intensive care unit (median, 3 days [IQR, 2–5 days] vs 2 days [IQR, 1–3 days]; P = .05) and longer duration of hospital stay (median, 4.5 days [IQR, 3–6.5 days] vs 3 days [IQR, 2–4 days]; P < .01). Similarly, the rate of reinterventions was higher among women, 25% vs 5% (P = .02).

For renal adverse events, there was a trend for a higher rate of renal function deterioration based in creatinine levels among women, when compared with men (18% vs 5%; P = .09). Multivariate analysis showed that the female gender was associated with an eight-fold increased risk of renal function deterioration (odds ratio, 8.1; 95% confidence interval, 6.1–10.8). The female gender was also identified as an independent factor for reinterventions at 30 days (odds ratio, 7.4; 95% confidence interval, 6.7–8.1), reported the investigators in the Journal of Vascular Surgery.