Gender differences on mortality and re-interventions after TEVAR for intact aneurysms of the thoracic aorta

Thoracic endovascular aortic repair (TEVAR) has been increasingly adopted in the treatment of intact thoracic aorta aneurysms (iTAA), offering a less invasive approach with good effectiveness. Women usually present with smaller aortas, while having greater aneurysm growth rates. How sex can affect mortality and re-interventions after TEVAR for iTAA is the aim of this review.

A search was conducted on PubMed databases to identify studies with gender-specific data on outcomes after TEVAR for iTAA. Primary endpoints were 30-day (or in-hospital) and mid-term mortality. Secondary endpoints were 30-day and mid-term secondary interventions.

Nine studies were included with a total of 4484 patients (2707 men and 1777 women). Thirty-day mortality ranged from 0% to 6% in female and from 1.1% to 5.3% for male patients. Three studies reported gender-specific mortality one year after TEVAR, ranging from 12% to 15.2% for female and from 8% to 16.8% in male patients. Six studies were found describing gender-related secondary intervention data.

Mortality after TEVAR for iTAA seems to be similar between genders. While there was a tendency for higher mortality in women, specially at 30-days, statistically significant differences were reported in only two studies. Re-interventions rates were higher in men in 4 of 6 studies, probably due to increased rates of endoleak in men, but no statically significant difference was found. Further studies with larger female population and longer follow-up are needed to firmly confirm differences among genders.