Ruby C. Lo1, Rodney P. Bensley1, Allen D. Hamdan1, Mark Wyers1, Elliot Chaikof1, Julie E. Adams2, Marc L. Schermerhorn1
1Vascular Surgery, BIDMC, Boston, MA; 2University of Vermont College of Medicine, Burlington, VT.
OBJECTIVES: Prior studies examining gender differences in AAA repair suggest there may be differences in presentation, suitability for EVAR, and outcomes between men and women.
METHODS: We used the Vascular Study Group of New England database to identify all patients undergoing EVAR or open AAA repair (OAR). We analyzed demographics, comorbidities, and procedural, and perioperative data. Results were compared using Fisher’s exact test.
RESULTS: A total of 4,193 patients underwent AAA repair (78% male, 54% EVAR). Women were less likely to undergo EVAR for intact aneurysms (50% vs. 60% of, p<.001) but not for ruptured aneurysms (27% vs. 21%, p=.25). Women were older (74 years vs. 72 years for intact, p<.001; 77.5 years vs. 73 years for rupture, p<.001) with smaller aortic diameters (56mm vs. 59mm for elective, p<.001; 71mm vs. 78mm for rupture, p=.005). Women had higher 30-day mortality after OAR for both intact (4% vs. 2%, p=.05) and rupture (48% vs. 33%, p=.03) repairs. However, 30-day mortality after EVAR was similar for both intact (1% in men vs. 1% in women, p=.58) and rupture (29% in men vs. 26% in women, p=1.00) repairs.
CONCLUSIONS: Women are undergoing EVAR at a higher rate than previously reported, being treated at older ages and smaller diameters, and rupture at smaller diameters than men. Thirty-day mortality is worse in women after OAR but comparable after EVAR.
AUTHOR DISCLOSURES: J. E. Adams, Nothing to disclose; R. P. Bensley, Nothing to disclose; E. Chaikof, Nothing to disclose; A. D. Hamdan, Nothing to disclose; R. C. Lo, Nothing to disclose; M. L. Schermerhorn, Endologix, Consulting fees or other remuneration (payment),Medtronic, Consulting fees or other remuneration (payment), Boston Scientific, Consulting fees or other remuneration (payment); M. Wyers, Nothing to disclose.
|
|
EVAR |
OAR |
|
|
Male (n=1,820) |
Female (n=453) |
p-value |
Male (n=1,436) |
Female (n=484) |
p-value |
Age (years), median |
All |
74 |
77 |
<.001 |
71 |
73 |
<.001 |
|
Intact |
74 |
76 |
<.001 |
70 |
73 |
<.001 |
|
Ruptured |
72 |
78 |
<.001 |
73 |
77 |
<.001 |
AAA diameter (mm), mean |
All |
58.4 |
56.6 |
.004 |
64.7 |
59.7 |
<.001 |
|
Elective |
57.2 |
55.4 |
<.001 |
60.8 |
57.3 |
<.001 |
|
Symptomatic |
65.4 |
62.5 |
0.39 |
69.3 |
65.4 |
.24 |
|
Ruptured |
75.3 |
72.4 |
0.56 |
79.1 |
70.8 |
.004 |
30-day mortality (%) |
All |
2 |
2 |
0.46 |
8 |
9 |
.39 |
|
Intact |
1 |
1 |
.58 |
2 |
4 |
.05 |
|
Ruptured |
29 |
26 |
1.00 |
33 |
48 |
.03 |
Posted April 2012