Two Studies Evaluate Role of Female Sex in EVAR Outcomes

January 13, 2015—Two studies evaluating the role of female sex in determining outcomes for endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms were published online ahead of print in the Journal of Vascular Surgery (JVS). In one study, Peter Gloviczki, MD, et al found that clinical presentation, comorbidities, and age (but not female sex) predict survival after EVAR of abdominal aortic aneurysms. In the other study, Christine Chung, MD, et al found that female sex is associated with more periprocedural complications, adjunctive arterial procedures, and increased endoleaks, but does not affect long-term reinterventions or survival.

In the first study, as summarized in JVS, Dr. Gloviczki, et al concluded that clinical presentation predicts early mortality and complications, whereas age predicts both early and late mortality after EVAR. Although women had an increased rate of complications and reinterventions, they did not have significantly higher mortality rates than men.

The investigators analyzed data from 934 consecutive patients (117 women and 817 men; mean age, 76 years) who underwent EVAR between 1997 and 2011 at a tertiary center. Comorbidity scores stratified patients into “low/normal risk” or “high risk” categories. The primary endpoint was mortality; secondary endpoints were morbidities, reinterventions, conversions, and ruptures. The investigators studied the association between surgical risk, female sex, age, and outcomes in the 870 asymptomatic patients. They found that both 30-day mortality and complication rates were higher in the high-risk patients versus the low/normal-risk patients; the reintervention rates were equivalent

As summarized in JVS, the study by Dr. Chung et al concluded that female sex is associated with more periprocedural complications, adjunctive arterial procedures, and increased endoleaks, but does not affect long-term reinterventions or survival. Further studies are warranted to elucidate the effect of sex on outcomes. These data should be considered when selecting EVAR for men and women, advised the investigators.

In the background to the study, the investigators noted that women have been underrepresented in trials that set guidelines for the management of aortic aneurysms and that several studies have reported inferior outcomes in women compared with men after EVAR. 

The present study investigated the relationship between sex and outcomes in 1,380 consecutive patients who underwent elective EVAR from 1992 to 2012. Baseline, intraoperative, and postoperative variables by sex were analyzed from a prospective database.

The study cohort was composed of 214 women (mean age, 77.8 years) and 1,166 men (mean age, 74.5 years). Women had less cardiac disease, shorter and more angulated aortic necks, and fewer iliac aneurysms. Women had more arterial reconstructions, more perioperative complications, and more in-hospital days. There was equivalent perioperative mortality. 

At a mean follow-up of 30.9 months, women and men experienced equivalent aneurysm-related deaths and overall survival, and there was no difference in rates of arterial reinterventions required for each sex during the follow-up period. However, women were more likely to develop endoleaks, reported the investigators in JVS.