The Role of Gender in Blunt Thoracic Aortic Injuries

Blunt thoracic aortic injuries (BTAIs) are the second leading cause of death in polytrauma patients. The majority of BTAIs occurs in males in the fifth decade; thoracic endovascular aortic repair (TEVAR) is the gold standard for the treatment. The role of gender in the natural history of BTAIs and in perioperative outcomes is still not clear.

A retrospective multicenter cohort study was conducted using dataset of the Aortic Trauma Foundation Global Registry. The primary outcome of this study was to determine if gender correlates with a different severity of the aortic injury. The secondary outcome was to determine if gender affects perioperative complications after TEVAR.

Within a total of 942 patients enrolled from February 2016 to May 2022, 623 patients met the inclusion criteria. Seventy-seven percent were males (age 44.2 ± 17.9 years). The BTAIs grades according to the Society for Vascular Surgery classification was: 158 (25.4%) grade I, 89 (14.3%) grade II, 310 (49.8%) grade III, and 66 (10.6%) grade IV. Males showed a higher probability to develop more severe aortic lesions compared to women (odds ratio 1.500 95% confidence interval; P = 0.035). TEVAR was performed in 384 patients and results reveal a higher risk of intraoperative and perioperative complications in women, despite no statistical significance was demonstrated (P > 0.05).

Gender-related differences in the natural history of BTAIs and in the outcomes of patients undergoing TEVAR are present. Females show a lower risk of developing more severe aortic injuries, but they seem to develop more intraoperative and perioperative complications when treated with TEVAR.