Mortality After Endovascular Aneurysm Repair Worse In Women

Women with abdominal aortic aneurysm (AAA) are more likely to undergo open repair than men with AAA, and they are more likely to die after endovascular (EVR) repair, according to new findings.

"The differential treatment benefit of EVR repair in women is concerning given the shift toward an EVR-first approach to AAA management," Niveditta Ramkumar of The Dartmouth Institute for Health Policy and Clinical Practice in Hanover, New Hampshire, and colleagues write in JAMA Network Open.

AAA is more common in men, while women present with smaller aneurysms with a higher risk of rupture and are less likely to undergo repair, the authors note. "However, it is unclear if sex is associated with AAA repair type and long-term mortality," they add.

To investigate, the authors looked at more than 16,000 patients 65 and older with AAA who underwent repair in 2003-2015, including 78% men. Twenty-seven percent of the women underwent surgical AAA repair, vs 18% of men.

Ten-year unadjusted survival with EVR was 23% for women and 37% for men (P<0.001), a difference that remained statistically significant after adjustment. Ten-year mortality after open surgery was 36% for men and 32% for women (P=0.22).

Women were 65% more likely to undergo open surgery than men, and had 13% greater risk-adjusted 10-year mortality after EVR. Mortality after open surgical repair was similar for men and women.

"The findings suggest that to improve the treatment benefit of AAA repair in women, physicians should recognize that the optimal, evidence-based strategy for AAA treatment to maximize postoperative survival may be sex specific and explore new techniques and devices to extend the benefits of EVR treatment to women," Ramkumar and colleagues write.

They note that women appear to have more complex aortic anatomy, and developing grafts specifically for female patients could help improve outcomes.

"In the era of personalized medicine, understanding sex-based differences in AAA treatment and mortality using real-world data with considerable representation of women appears to be crucial to developing AAA management strategies that offer the greatest benefit of AAA repair to both men and women," they conclude.

Ramkumar was not available for an interview by press time.

—Reuters Staff

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