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Home > Vascular Annual Meeting^® > PP19. TEVAR in Female Patients: Increased Aortic...

PP19. TEVAR in Female Patients: Increased Aortic Coverage Is Associated with a Higher Risk of Spinal Cord Ischemia

Tejas R. Shah, Stephen M. Bauer, Neal S. Cayne, Thomas Maldonado, Caron Rockman
New York University Medical Center, New York, NY

OBJECTIVES: There is a paucity of literature regarding thoracic endovascular aneurysm repair (TEVAR) in women. We report our institutional experience with TEVAR in women.

METHODS: A retrospective chart review was performed. Case planning was done with CTa. Patients with small access vessels received a 10mm common iliac artery (CIA) conduit. Patients received a CTa 30-days post-operatively. Post-operative stroke was diagnosed clinically and by cerebral imaging. Spinal cord ischemia (SCI) was diagnosed clinically with negative cerebral imaging.

RESULTS: TEVAR was performed in 51 patients for a variety of aortic pathologies; of these 29 (56%) were female. The mean age of women was 73.5 years. Mean TAA diameter was larger for women than for men (5.9 cm vs. 4.7 cm). TEVAR was performed more often on an urgent basis in women as compared to men (20.7% vs. 9.5%, p=ns). There was a trend towards pain as the predominant presenting symptom in women as compared to men (44.8% vs. 22.7%, p=ns). There was a statistically significant difference in the need for a CIA conduit in women compared to men (48.3% vs. 20.0%, p<0.05). This was not associated with an increase in peripheral ischemic complications or an increase length of stay (LOS). There were no differences in endoleak rate, stroke, or post-operative death. Although not statistically significant, there was a concerning trend towards an increase in paraplegia in women, 10.3% versus 4.8%. This may be related to the statistically significant increase in the total length of aortic coverage required in women compared to men, 18.2 cm versus 15.2 cm (p<0.05).

CONCLUSIONS: Our data suggests that TEVAR in women is safe and effective. Women presented more frequently with indications for urgent intervention. As expected, women require a conduit more often due to smaller access vessel size, but this does not increase the rate of peripheral ischemic complications or LOS. The length of aortic coverage is greater in women than in men, and this may be related to their being treated for larger aneurysms and more advanced or diffuse disease. The increase in length of coverage appears to be associated with a concerning increase in postoperative paraplegia. Female patients undergoing TEVAR should be considered for prophylactic maneuvers to prevent SCI, including minimizing length of coverage.

AUTHOR DISCLOSURES: T.R. Shah, None; S.M. Bauer, None; N.S. Cayne, None; T. Maldonado, None; C. Rockman, None.