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Gender differences in abdominal aortic aneurysm presentation, repair, and mortality in the Vascular Study Group of New England.
J Vasc Surg. 2013 May; 57(5):1261-8, 1268.e1-5.JV

Abstract

OBJECTIVE

Prior studies of gender differences in abdominal aortic aneurysm (AAA) repair suggest there may be differences in presentation, suitability for endovascular aneurysm repair (EVAR), and outcomes between men and women.

METHODS

We used the Vascular Study Group of New England database to identify all patients undergoing EVAR or open AAA repair. We analyzed demographics, comorbidities, and procedural, and perioperative data. Results were compared using the Fisher exact test and the Student t-test. Multivariable logistic regression and Cox proportional hazards modeling were performed to identify predictors of mortality.

RESULTS

We identified 4026 patients (78% men) who underwent AAA repair (54% EVAR). Women were less likely than men to undergo EVAR for intact aneurysms (50% vs 60% of intact AAA repair; P < .001) but not for ruptured aneurysms (26% vs 20%; P = .23). Women were older (median age, 75 vs 72 years for intact; P < .001; 78 vs 73 years for rupture; P < .001) with smaller aortic diameters (57 vs 59 mm for elective; P < .001; 71 vs 79 mm for rupture; P < .001). Arterial injury was more common in women (5.4% vs 2.7%; P = .013) among patients undergoing EVAR for intact aneurysms. Women stayed in the hospital longer (4.3 vs 2.7 days; P = .018) and had lower odds of being discharged home, even after adjusting for age. Among patients undergoing open repair for intact aneurysms, women more frequently experienced leg ischemia/emboli (4% vs 1%; P = .001) and bowel ischemia (5% vs 3%; P = .044). Women had higher 30-day mortality after OAR for intact (4% vs 2%; P = .03) and rupture (48% vs 34%; P = .03) repairs. However, 30-day mortality after EVAR was similar for intact (1% in men vs 1% in women; P = .57) and rupture (29% in men vs 27% in women; P > .99) repairs. Late survival was worse in women than men only for patients undergoing open repair of ruptured aneurysms (hazard ratio, 1.8; 95% confidence interval, 1.0-3.1; P = .04). After controlling for age, type of repair, urgency at presentation (ie, elective/intact vs ruptured), comorbidities, and other relevant risk factors, gender was not predictive of 30-day or 1-year mortality.

CONCLUSIONS

Women with AAAs are being treated at older ages and smaller AAA diameters and are undergoing rupture repair at smaller diameters than men. Women are more likely to experience perioperative complications as a result of less favorable vascular anatomy. Age >80 years, comorbidity, presentation, and type of repair are more important predictors of mortality than gender.

Authors+Show Affiliations

Department of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass 02215, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

23384493

Citation

Lo, Ruby C., et al. "Gender Differences in Abdominal Aortic Aneurysm Presentation, Repair, and Mortality in the Vascular Study Group of New England." Journal of Vascular Surgery, vol. 57, no. 5, 2013, pp. 1261-8, 1268.e1-5.
Lo RC, Bensley RP, Hamdan AD, et al. Gender differences in abdominal aortic aneurysm presentation, repair, and mortality in the Vascular Study Group of New England. J Vasc Surg. 2013;57(5):1261-8, 1268.e1-5.
Lo, R. C., Bensley, R. P., Hamdan, A. D., Wyers, M., Adams, J. E., & Schermerhorn, M. L. (2013). Gender differences in abdominal aortic aneurysm presentation, repair, and mortality in the Vascular Study Group of New England. Journal of Vascular Surgery, 57(5), 1261-8, e1-5. https://doi.org/10.1016/j.jvs.2012.11.039
Lo RC, et al. Gender Differences in Abdominal Aortic Aneurysm Presentation, Repair, and Mortality in the Vascular Study Group of New England. J Vasc Surg. 2013;57(5):1261-8, 1268.e1-5. PubMed PMID: 23384493.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Gender differences in abdominal aortic aneurysm presentation, repair, and mortality in the Vascular Study Group of New England. AU - Lo,Ruby C, AU - Bensley,Rodney P, AU - Hamdan,Allen D, AU - Wyers,Mark, AU - Adams,Julie E, AU - Schermerhorn,Marc L, AU - ,, Y1 - 2013/02/04/ PY - 2012/09/07/received PY - 2012/10/30/revised PY - 2012/11/06/accepted PY - 2013/2/7/entrez PY - 2013/2/7/pubmed PY - 2013/6/19/medline SP - 1261-8, 1268.e1-5 JF - Journal of vascular surgery JO - J Vasc Surg VL - 57 IS - 5 N2 - OBJECTIVE: Prior studies of gender differences in abdominal aortic aneurysm (AAA) repair suggest there may be differences in presentation, suitability for endovascular aneurysm repair (EVAR), and outcomes between men and women. METHODS: We used the Vascular Study Group of New England database to identify all patients undergoing EVAR or open AAA repair. We analyzed demographics, comorbidities, and procedural, and perioperative data. Results were compared using the Fisher exact test and the Student t-test. Multivariable logistic regression and Cox proportional hazards modeling were performed to identify predictors of mortality. RESULTS: We identified 4026 patients (78% men) who underwent AAA repair (54% EVAR). Women were less likely than men to undergo EVAR for intact aneurysms (50% vs 60% of intact AAA repair; P < .001) but not for ruptured aneurysms (26% vs 20%; P = .23). Women were older (median age, 75 vs 72 years for intact; P < .001; 78 vs 73 years for rupture; P < .001) with smaller aortic diameters (57 vs 59 mm for elective; P < .001; 71 vs 79 mm for rupture; P < .001). Arterial injury was more common in women (5.4% vs 2.7%; P = .013) among patients undergoing EVAR for intact aneurysms. Women stayed in the hospital longer (4.3 vs 2.7 days; P = .018) and had lower odds of being discharged home, even after adjusting for age. Among patients undergoing open repair for intact aneurysms, women more frequently experienced leg ischemia/emboli (4% vs 1%; P = .001) and bowel ischemia (5% vs 3%; P = .044). Women had higher 30-day mortality after OAR for intact (4% vs 2%; P = .03) and rupture (48% vs 34%; P = .03) repairs. However, 30-day mortality after EVAR was similar for intact (1% in men vs 1% in women; P = .57) and rupture (29% in men vs 27% in women; P > .99) repairs. Late survival was worse in women than men only for patients undergoing open repair of ruptured aneurysms (hazard ratio, 1.8; 95% confidence interval, 1.0-3.1; P = .04). After controlling for age, type of repair, urgency at presentation (ie, elective/intact vs ruptured), comorbidities, and other relevant risk factors, gender was not predictive of 30-day or 1-year mortality. CONCLUSIONS: Women with AAAs are being treated at older ages and smaller AAA diameters and are undergoing rupture repair at smaller diameters than men. Women are more likely to experience perioperative complications as a result of less favorable vascular anatomy. Age >80 years, comorbidity, presentation, and type of repair are more important predictors of mortality than gender. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/23384493/Gender_differences_in_abdominal_aortic_aneurysm_presentation_repair_and_mortality_in_the_Vascular_Study_Group_of_New_England_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(12)02431-7 DB - PRIME DP - Unbound Medicine ER -