Gender Gap in Aortic Repair Compare

A new study shows that women undergoing EVAR had a higher incidence of complications

Women have enough to worry about.  That’s why TBE regrets having to report on a recent study in the Journal of Vascular Surgery on the outcomes of women undergoing various procedures for abdominal aortic aneurysms. The study compared open surgery and endovascular aortic aneurysm repair (EVAR) for elective and emergency cases.

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EVAR is a minimally invasive procedure that slips a fabric tube up into the aorta to conduct blood through the diseased portion of the vessel. EVAR is preferable to open surgery in that patients recover more quickly and usually with fewer complications than open surgery. But women seem to be having problems with it. The study shows that women undergoing EVAR had a higher incidence of complications, primarily related to arterial rupture. They also had a higher rate of post-operative complications and a higher thirty-day mortality rate than men – about 3.4 times higher, to be precise. By contrast, there was no gender disparity in outcomes for open surgery.

Matthew Eagleton, MD, a vascular surgeon at Cleveland Clinic, is not particularly surprised.  He notes an earlier study at Cleveland Clinic that showed similar disparate outcomes. And more recently, a major study from theAmericanCollegeof Surgeons National Surgical Quality Improvement Program, also showed women having increased morbidity and mortality compared to men.

The problem, Dr. Eagleton says, has to do with the fact that women’s aortas, especially the iliac arteries in the hips, are smaller than men’s. EVAR is still a developing technology, and so far, the devices that are available for deploying the tubular conduit into the aorta are less-than-optimally sized for the generally smaller anatomies of women – and some surgeons may be a jumping the gun by utilizing EVAR where it may not be anatomically appropriate.

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“Despite the results of this trial, several studies have demonstrated a survival advantage of EVAR versus open surgical repair in both men and women,” says Dr. Eagleton. “In fact in women, this survival advantage is realized for a longer period of time compared to men – six years for women versus two years for men.  So EVAR is really a viable option for all patients requiring repair of their abdominal aortic aneurysm. Care must be taken, however, to assure that patients are suitable candidates for whichever mode of repair they undergo.”

References:

  1. Mehta M, Byrne WJ, Robinson H, Roddy SP, et al. Women derive less benefit from elective endovascular aneurysm repair than men. J Vasc Surg 2012; 55: 906-13.
  2. Ouriel K, Greenberg RK, Clair DG, et al. Endovascular aneurysm repair: Gender-specific results. J Vasc Surg 2003; 38: 93-8.
  3. Abedi N, Davenport N, Xenos, DL, et al. Gender and 30-day outcomes in patients undergoing endovascular aneurysm repair (EVAR): an analysis using the ACS NSQIP dataset. J Vasc Surg 2009; 50: 486-91. 
  4. Egorova NN, Vouyouka N, Ageliki, G, et al. Effect of gender on long-term survival after abdominal aortic aneurysm repair based on results from Medicare national database. J Vasc Surg 2001; 54: 1-12.

 

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