Sex disparity in thoracic aneurysm repair linked to device size

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A study published in Journal of Vascular Surgery is a “call to action” for device companies.

Women are more likely than men to suffer complications, including death, from thoracic endovascular aortic repair. The reason: surgical devices too large for women’s anatomy, according to a new study in Journal of Vascular Surgery.

“This study is a call to action to decrease device size to improve outcomes for women,” said Christopher Abularrage, MD, assistant professor of surgery at Johns Hopkins University and one of the study’s investigators.

Researchers reviewed 2005-2011 data on TEVAR and found that women were nearly three times as likely to require a conduit during surgery, significantly increasing their risk of death.

Researchers also found that women had longer operative times and were at greater risk for bleeding. An abstract of the study is available at www.vsweb.org/Gender. A fact sheet for patients on thoracic aneurysms and their repair is available at www.vsweb.org/TAAforpatients.

“With the device size of TEVAR delivery systems and women’s generally smaller iliac arteries, women are more likely to have complicated access issues that directly result in increased blood loss and death,” said Dr. Abularrage.

Thoracic aortic aneurysm affects 15,000 Americans each year. Previous studies have shown that women are at greater risk for death after minimally invasive surgical repair of these aneurysms, but until now, there has been no well-designed study to identify the cause of this gender disparity.

“Everyone had an inkling, but now we have proof that device size is an issue,” said Julie Freischlag, MD, chair of the department of surgery at Johns Hopkins University, one of the study’s investigators and president of the Society for Vascular Surgery.

“One of the early challenges in treating vascular disease in women was recognizing the illness–for a long time we believed being female protected against vascular disease. Now we’re past that and realize that there is a whole population of patients that could be treated better with devices better matched to their anatomy.”

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