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Female sex independently predicts mortality after thoracic endovascular aortic repair for intact descending thoracic aortic aneurysms.
J Vasc Surg. 2017 07; 66(1):2-8.JV

Abstract

OBJECTIVE

Whereas sex differences in the pathogenesis, presentation, and outcomes of repair for abdominal aortic aneurysms are well studied, less is known about sex differences after thoracic endovascular aortic repair (TEVAR). The goal of this study was to evaluate the association between sex and morbidity and mortality after TEVAR.

METHODS

A retrospective review of all TEVARs in the Society for Vascular Surgery Vascular Quality Initiative (VQI) registry from 2011 to 2015 was conducted, excluding those with dissection, trauma, and rupture. Statistical analysis was performed using the Fisher exact test and the Mann-Whitney U test for categorical and continuous variables. Multivariable logistic regression and Cox hazards modeling were used to account for differences in demographics, comorbidities, and aneurysm characteristics in 30-day mortality and long-term survival.

RESULTS

We identified 2574 patients (40% women) who underwent TEVAR. Women were older, were less likely to be white, and had smaller aortic diameters but larger aortic size indices (aortic diameter/body surface area). Women also had more chronic obstructive pulmonary disease but less coronary artery disease and fewer coronary interventions. Women were more likely to be symptomatic at presentation and subsequently to have a nonelective procedure. Women had higher estimated blood loss >500 mL (20% vs 17%; P = .04), were more likely to be transfused (29% vs 21%; P < .001), and more frequently underwent iliac access procedures (4.3% vs 2.1%; P < .01). Operative time and left subclavian intervention were similar. Postoperatively, women had increased median hospital (5 vs 4 days; P < .001) and intensive care unit (2.5 vs 2 days; P < .001) lengths of stay and were less likely to be discharged home (75% vs 86%; P < .001). Mortality was higher for women at 30 days (5.4% vs 3.3%; P < .01) and 1 year (9.8% vs 6.3%; P < .01). After adjusting for age, aortic size index, symptoms, and comorbidities, female sex remained independently predictive of 30-day mortality (odds ratio, 1.5; 95% confidence interval, 1.1-2.1, P < .01) and long-term mortality (hazard ratio, 1.3; 95% confidence interval, 1.03-1.6; P = .02).

CONCLUSIONS

Even after adjusting for differences in age and comorbidities, female patients have higher perioperative mortality and lower long-term survival after TEVAR. These findings, along with the rupture risk by sex, should be considered by clinicians in determining the timing of intervention.

Authors+Show Affiliations

Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass; Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass.Division of Vascular and Endovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa.Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins Hospital, Baltimore, Md.Division of Vascular and Endovascular Surgery, University of Virginia Health System, Charlottesville, Va.Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla.Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass. Electronic address: mscherm@bidmc.harvard.edu.No affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

28259576

Citation

Deery, Sarah E., et al. "Female Sex Independently Predicts Mortality After Thoracic Endovascular Aortic Repair for Intact Descending Thoracic Aortic Aneurysms." Journal of Vascular Surgery, vol. 66, no. 1, 2017, pp. 2-8.
Deery SE, Shean KE, Wang GJ, et al. Female sex independently predicts mortality after thoracic endovascular aortic repair for intact descending thoracic aortic aneurysms. J Vasc Surg. 2017;66(1):2-8.
Deery, S. E., Shean, K. E., Wang, G. J., Black, J. H., Upchurch, G. R., Giles, K. A., Patel, V. I., & Schermerhorn, M. L. (2017). Female sex independently predicts mortality after thoracic endovascular aortic repair for intact descending thoracic aortic aneurysms. Journal of Vascular Surgery, 66(1), 2-8. https://doi.org/10.1016/j.jvs.2016.12.103
Deery SE, et al. Female Sex Independently Predicts Mortality After Thoracic Endovascular Aortic Repair for Intact Descending Thoracic Aortic Aneurysms. J Vasc Surg. 2017;66(1):2-8. PubMed PMID: 28259576.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Female sex independently predicts mortality after thoracic endovascular aortic repair for intact descending thoracic aortic aneurysms. AU - Deery,Sarah E, AU - Shean,Katie E, AU - Wang,Grace J, AU - Black,James H,3rd AU - Upchurch,Gilbert R,Jr AU - Giles,Kristina A, AU - Patel,Virendra I, AU - Schermerhorn,Marc L, AU - ,, Y1 - 2017/03/01/ PY - 2016/10/03/received PY - 2016/12/06/accepted PY - 2017/3/6/pubmed PY - 2017/7/14/medline PY - 2017/3/6/entrez SP - 2 EP - 8 JF - Journal of vascular surgery JO - J Vasc Surg VL - 66 IS - 1 N2 - OBJECTIVE: Whereas sex differences in the pathogenesis, presentation, and outcomes of repair for abdominal aortic aneurysms are well studied, less is known about sex differences after thoracic endovascular aortic repair (TEVAR). The goal of this study was to evaluate the association between sex and morbidity and mortality after TEVAR. METHODS: A retrospective review of all TEVARs in the Society for Vascular Surgery Vascular Quality Initiative (VQI) registry from 2011 to 2015 was conducted, excluding those with dissection, trauma, and rupture. Statistical analysis was performed using the Fisher exact test and the Mann-Whitney U test for categorical and continuous variables. Multivariable logistic regression and Cox hazards modeling were used to account for differences in demographics, comorbidities, and aneurysm characteristics in 30-day mortality and long-term survival. RESULTS: We identified 2574 patients (40% women) who underwent TEVAR. Women were older, were less likely to be white, and had smaller aortic diameters but larger aortic size indices (aortic diameter/body surface area). Women also had more chronic obstructive pulmonary disease but less coronary artery disease and fewer coronary interventions. Women were more likely to be symptomatic at presentation and subsequently to have a nonelective procedure. Women had higher estimated blood loss >500 mL (20% vs 17%; P = .04), were more likely to be transfused (29% vs 21%; P < .001), and more frequently underwent iliac access procedures (4.3% vs 2.1%; P < .01). Operative time and left subclavian intervention were similar. Postoperatively, women had increased median hospital (5 vs 4 days; P < .001) and intensive care unit (2.5 vs 2 days; P < .001) lengths of stay and were less likely to be discharged home (75% vs 86%; P < .001). Mortality was higher for women at 30 days (5.4% vs 3.3%; P < .01) and 1 year (9.8% vs 6.3%; P < .01). After adjusting for age, aortic size index, symptoms, and comorbidities, female sex remained independently predictive of 30-day mortality (odds ratio, 1.5; 95% confidence interval, 1.1-2.1, P < .01) and long-term mortality (hazard ratio, 1.3; 95% confidence interval, 1.03-1.6; P = .02). CONCLUSIONS: Even after adjusting for differences in age and comorbidities, female patients have higher perioperative mortality and lower long-term survival after TEVAR. These findings, along with the rupture risk by sex, should be considered by clinicians in determining the timing of intervention. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/28259576/Female_sex_independently_predicts_mortality_after_thoracic_endovascular_aortic_repair_for_intact_descending_thoracic_aortic_aneurysms_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(17)30078-2 DB - PRIME DP - Unbound Medicine ER -