Current management practices for thoracic aortic aneurysms are associated with increased symptomatic presentation in...

Sex-specific differences exist in the natural history and clinical outcomes associated with aortic aneurysms. This study evaluated contemporary outcomes associated with thoracic endovascular aneurysm repair (TEVAR) for descending thoracic aortic aneurysms and analyzed management paradigm trends over a 10-year period.

The Vascular Quality Initiative was queried from 2013 to 2023 for all patients undergoing TEVAR for descending thoracic aortic aneurysm. A secondary analysis was performed for patients who underwent TEVAR with aneurysm size of less than 55 mm. The primary outcome studied was symptomatic presentation and/or rupture. Aneurysm size, adjusted using aortic size indices, before intervention was analyzed over the study period.

We included 2383 patients, including 1183 females and 1200 males, in this study. The small aneurysm cohort included 702 patients with 357 female and 345 male patients. Documented cardiovascular comorbidities including hypertension, heart failure, end-stage renal disease, and cerebrovascular diseases were similar between males and females. Body surface area (BSA) was greater in males overall (2.0 vs 1.7; P < .005). Symptomatic or ruptured aneurysm presentation was more common in females overall (35.9% vs 29.1%; P < .005) and a similar association was seen in the small aneurysm cohort. The BSA-adjusted aortic size index (ASI) was significantly larger in females compared with males despite similar un-normalized aortic aneurysm diameters. BSA-adjusted ASI was an independent predictor of symptomatic presentation or rupture (odds ratio, 1.3; 95% confidence interval, 1.2-1.5). The BSA-adjusted ASI was greater for females than males across the entire study period.

Female patients undergoing TEVAR for DTAAs were much more likely than male patients to present with symptomatic aneurysms or with aneurysm rupture. BSA-adjusted ASI was greater in females than males and independently predicted symptomatic or rupture presentation. Despite this finding, trends in median size at time of intervention have not changed significantly. Females remain at an increased risk of adverse presentation owing to continued reliance on maximum aortic diameter as the primary intervention criterion.