Female sex is associated with reintervention and mortality following elective EVAR

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Taylor Corsi

Women are more likely to die within five years of having elective surgery to repair an abdominal aortic aneurysm (AAA) or need repeat surgery, according to a recent study.

Writing in the Journal of Vascular SurgeryTaylor Corsi, BS, a medical student at Rutgers University, Piscataway, New Jersey, and colleagues said the disparity between men and women who undergo the surgery needs to be addressed by including women in early aortic aneurysm screening as well as incorporating more women in clinical trials of aortic medical devices.

The data were originally presented at the 2021 annual meeting of the Eastern Vascular Society (EVS) in Charleston, South Carolina. An update was delivered at the 2022 Society for Clinical Vascular Surgery (SCVS) Annual Symposium held in Las Vegas in March.

“Despite the fact that men are more likely to be diagnosed with and to die from AAA, women are still under-represented in many clinical trials for the aortic devices used in minimally invasive aortic aneurysm repair,” said William Beckerman, MD, a vascular surgeon at Robert Wood Johnson University Hospital, New Brunswick, New Jersey, who led the study. “As men and women are known to have different aortic anatomy, this study highlights the need for an increased focus on, and inclusion of women in aortic device creation and subsequent trial enrollment.”

William Beckerman

Researchers conducted a retrospective chart review of 273 patients—75% of them male and 25% female—who underwent endovascular aneurysm repair (EVAR) from 2011 to 2020 at a tertiary medical centre. The idea was to learn how many patients survived five years beyond the surgery and how many needed reintervention. The females were older on average than the males and were more likely to have chronic obstructive pulmonary disease, require home oxygen therapy or dialysis.

Despite some variations in morbidities, the differences in survival and reintervention were statistically significant, the researchers found. Females had significantly lower survival rates at five years as well as a higher rate of reintervention within those years.

“Our question was, knowing all these things that we do, do men and women have different outcomes—even though they are being operated on by the same surgeon, at the same hospital with the same devices?” Beckerman said. “The answer to that was ‘yes.’ Men and women do differently after surgery.”

“Our data suggests factors beyond patient age and baseline health risk likely contribute to greater surgical morbidity and mortality for females following elective EVAR,” Beckerman added.

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