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Sex Specific Analysis of Outcomes after Fenestrated and Branched Endovascular Aortic Repair: A Population Based
Maria Talvitie1, Rebecka Hultgren1, Göran Lundberg1
1Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden.
Objective:
Worse women's outcomes after elective standard endovascular aneurysm repair have been widely reported. Similar data have surfaced from cohorts undergoing fenestrated and branched repair; however, studies reporting from a sex perspective are rare and mostly limited to single centre designs. This study aimed to examine survival following nationwide complex endovascular repair according to patient sex, and to identify sex specific causes of death.
Methods:
This was a population based, retrospective cohort study. Patients treated with complex endovascular repair for intact abdominal aortic aneurysms in Sweden, between May 2018 and February 2024, were identified from the Swedish National Registry for Vascular Surgery. The primary outcome was all cause death. Sex specific risk factors for short term and overall mortality were investigated in stratified regression models. Complications, vascular and systemic, were listed in sex strata at 30 days.
Results:
Six hundred and forty-seven patients were treated with fenestrated and branched endografts; 116 (17.9%) were women. There were no differences in age (median 76 years), comorbid profiles, or abdominal aortic aneurysm locations (69.1% juxtarenal) between the sexes. Women had a higher mortality rate at all timepoints (p < .001) with the largest mortality gap forming within 90 days (7.8% vs. 2.6%). Accordingly, female sex was an independent risk factor for 90 day death by an odds ratio of 3.4 (95% confidence interval 1.4 - 8.3). Comorbidities as predictors in sex stratified models did not explain differences in mortality. However, complications (specifically, iatrogenic vascular injury, high blood loss, and abdominal compartment syndrome) were four to six times more common and largely found in women who died.
Conclusion:
Mortality sex differences after complex endovascular repair are due to a marked excess of early deaths in women. Neither age nor comorbidities, but complications are the culprits. Fenestrated and or branched endovascular aneurysm repair failure to rescue studies are called for.
