Effects of Sex-Specific Differences on Long-Term Outcomes Following Endovascular Aneurysm Repair

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Conference Proceeding

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Journal of Vascular Surgery



Short- and mid-term follow-up studies have shown that women have worse graft-related outcomes than men after endovascular aneurysm repair for abdominal aortic aneurysms. We reviewed sex-specific differences in outcomes on long-term follow-up.


We reviewed all elective EVARs performed at our institution from January 2000 to January 2013. Demographics, comorbidities, device dimensions, and 30-day outcomes were recorded. Aortoiliac diameter, tortuosity, angulation, neck length, and calcification were determined from index and yearly follow-up imaging. The primary long-term outcomes were mortality, graft-related complications, and reinterventions.


We identified 403 consecutive patients with nonruptured abdominal aortic aneurysm, adequate clinical follow-up, and surveillance imaging. There were 318 men (82%) and 70 women (18%) with a median follow-up of 13.7 years (range, 13.6-13.9 years). There was a lower incidence of diabetes (P = .02) and peripheral vascular disease (P = .03) in women; however, age, demographics, and other comorbidities did not differ significantly. Women had smaller aorto-iliac dimensions, shorter neck length, and a higher degree of angulation of the infrarenal aorta and required smaller device dimensions when compared with men (Table). There were no significant differences in access site complications including failure of primary closure or wound infection (13.6% vs 8.9%; P = .28). On long-term follow-up, all-cause reintervention (30.0% vs 28.6%; P = .82) was similar between women and men; however, women had increased stent migration (7.1% vs 0.9%; P≤ .01). Women had a higher aneurysm-related mortality (24.2% vs 11.5%) that was not statistically significant. There was no difference in Kaplan-Meier median survival estimates (Figure).


Despite anatomically smaller vessels and a higher rate of graft migration in women, there does not appear to be a significant difference in reinterventions or mortality on long-term follow-up between men and women undergoing EVAR. Differences in the rate of diabetes and peripheral vascular disease in women also did not impact long-term outcomes. Further studies with larger cohorts are necessary to corroborate these findings.





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Midwestern Vascular Surgical Society Annual Meeting, September 7-9, 2023, Minneapolis, MN.