Sex-Based Differences of Thoracic Endovascular Aortic Repair for Stanford Type B Aortic Dissections

There is a paucity of data on sex-based differences in outcomes after thoracic endovascular aortic repair (TEVAR) performed for Stanford type B aortic dissections (TBADs). Examining the predictive role of sex could shape future clinical guidelines for TEVAR. Thus, this study aims to evaluate the association between sex and postoperative outcomes after TEVAR performed for TBAD.

This is a retrospective cohort study utilizing the Vascular Quality Initiative from 2011 to 2024. We included all patients undergoing TEVAR for TBAD with entry tear zones > zone 0. Patients who presented with rupture, had a history of connective tissue disease and underwent conversion to open repair were excluded. Primary outcomes were 30-day mortality, postoperative stroke, myocardial infarction (MI), spinal cord ischemia (SCI), aorta-related reintervention and access-related reintervention. The secondary outcome was freedom from all-cause mortality (ACM) at 1 year.

A total of 5,117 patients underwent TEVAR for TBAD, of which 1,553 (30.3%) were women. Female patients were more likely to have a smaller aortic diameter compared to male patients (42.8 ± 11.5 vs. 45.8 ± 14.3; P < 0.001). After adjusting for potential confounders, there were no significant differences in 30-day mortality, stroke, MI, SCI, and aorta-related. reintervention between male and female patients. However, female patients were significantly more likely to undergo postoperative access-related reintervention (adjusted odds ratio = 2.4 [95% confidence interval [CI]: 1.1-5.0]; P = 0.023) compared to male patients. Freedom from ACM at 1 year was similar between males and females (adjusted hazard ratio = 1 [95% CI: 0.8-1.2]; P = 0.955).

In this study using large, real-world data, female patients undergoing TEVAR for TBAD showed an increased risk of postoperative access-related reintervention, possibly due to smaller access vessel diameter. Development of devices that better fit female anatomy may help mitigate these risks in the future.