Female sex is associated with comparable 5-year outcomes after contemporary endovascular aneurysm repair despite more challenging anatomy

Thomas F X O'Donnell; Hence J Verhagen; Giovanni Pratesi; Carlo Pratesi; Joep A W Teijink; Frank E G Vermassen; Patrice Mwipatayi; Thomas L Forbes; Marc L Schermerhorn

doi:10.1016/j.jvs.2019.05.065

Female sex is associated with comparable 5-year outcomes after contemporary endovascular aneurysm repair despite more challenging anatomy

Thomas F X O'Donnell, Hence J Verhagen, Giovanni Pratesi, Carlo Pratesi, Joep A W Teijink, Frank E G Vermassen, Patrice Mwipatayi, Thomas L Forbes, Marc L Schermerhorn^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: Women with abdominal aortic aneurysms less often meet anatomic criteria for endovascular repair and experience worse perioperative and long-term survival.

METHODS: We compared long-term survival, aneurysm-related mortality, and rates of endoleaks and reinterventions between male and female patients in the Endurant Stent Graft Natural Selection Global Postmarket Registry (ENGAGE) using 2:1 propensity score matching.

RESULTS: There were 1130 male patients and 133 female patients, yielding 399 patients after matching (266 male patients, 133 female patients). Female patients were older, with smaller aneurysms, smaller iliac arteries, and shorter, more angulated necks, and they were more often treated outside the device instructions for use (all P < .001). Through 5 years, female patients experienced overall mortality comparable to that of well-matched male patients (34% vs 38%, respectively; hazard ratio, 0.89 [0.61-1.29]; P = .54) and lower aneurysm-related mortality (0% vs 3%; P = .047). Female patients experienced higher rates of any postoperative type IA endoleak through 5 years (10% vs 1%; P < .001) but comparable rates of secondary endovascular procedures (14% vs 16%; P = .40). Female sex was independently associated with significantly higher risk of long-term type IA endoleaks (hazard ratio, 4.8 [1.2-20.8]; P = .04), even after accounting for anatomic factors. No female patient experienced aneurysm rupture during follow-up, and only one female patient underwent conversion to open repair.

CONCLUSIONS: Despite more challenging anatomy, female patients in the ENGAGE registry had long-term outcomes comparable to those of male patients. However, female patients experienced higher rates of type IA endoleaks. Although standard endovascular aneurysm repair remains a viable solution for most women, whether high-risk patients may be better served with open surgery, custom-made devices, EndoAnchors (Aptus Endosystems, Sunnyvale, Calif), or chimneys is worthy of further study.

Original language	English
Pages (from-to)	1179-1189
Number of pages	11
Journal	Journal of Vascular Surgery
Volume	71
Issue number	4
DOIs	https://doi.org/10.1016/j.jvs.2019.05.065
Publication status	Published - Apr 2020

Keywords

Abdominal aortic aneurysm
Sex
Endovascular aneurysm repair
Gender
EVAR
ABDOMINAL AORTIC-ANEURYSM
ENDURANT STENT GRAFT
REGIONAL-VARIATION
MORTALITY
GENDER
SURGERY
WOMEN
TRIAL
SURVEILLANCE
PERFORMANCE

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O'Donnell, T. F. X., Verhagen, H. J., Pratesi, G., Pratesi, C., Teijink, J. A. W., Vermassen, F. E. G., Mwipatayi, P., Forbes, T. L., & Schermerhorn, M. L. (2020). Female sex is associated with comparable 5-year outcomes after contemporary endovascular aneurysm repair despite more challenging anatomy. Journal of Vascular Surgery, 71(4), 1179-1189. https://doi.org/10.1016/j.jvs.2019.05.065

@article{b74b71082bb84c7aa482f5a7984ad31f,

title = "Female sex is associated with comparable 5-year outcomes after contemporary endovascular aneurysm repair despite more challenging anatomy",

abstract = "BACKGROUND: Women with abdominal aortic aneurysms less often meet anatomic criteria for endovascular repair and experience worse perioperative and long-term survival.METHODS: We compared long-term survival, aneurysm-related mortality, and rates of endoleaks and reinterventions between male and female patients in the Endurant Stent Graft Natural Selection Global Postmarket Registry (ENGAGE) using 2:1 propensity score matching.RESULTS: There were 1130 male patients and 133 female patients, yielding 399 patients after matching (266 male patients, 133 female patients). Female patients were older, with smaller aneurysms, smaller iliac arteries, and shorter, more angulated necks, and they were more often treated outside the device instructions for use (all P < .001). Through 5 years, female patients experienced overall mortality comparable to that of well-matched male patients (34% vs 38%, respectively; hazard ratio, 0.89 [0.61-1.29]; P = .54) and lower aneurysm-related mortality (0% vs 3%; P = .047). Female patients experienced higher rates of any postoperative type IA endoleak through 5 years (10% vs 1%; P < .001) but comparable rates of secondary endovascular procedures (14% vs 16%; P = .40). Female sex was independently associated with significantly higher risk of long-term type IA endoleaks (hazard ratio, 4.8 [1.2-20.8]; P = .04), even after accounting for anatomic factors. No female patient experienced aneurysm rupture during follow-up, and only one female patient underwent conversion to open repair.CONCLUSIONS: Despite more challenging anatomy, female patients in the ENGAGE registry had long-term outcomes comparable to those of male patients. However, female patients experienced higher rates of type IA endoleaks. Although standard endovascular aneurysm repair remains a viable solution for most women, whether high-risk patients may be better served with open surgery, custom-made devices, EndoAnchors (Aptus Endosystems, Sunnyvale, Calif), or chimneys is worthy of further study.",

keywords = "Abdominal aortic aneurysm, Sex, Endovascular aneurysm repair, Gender, EVAR, ABDOMINAL AORTIC-ANEURYSM, ENDURANT STENT GRAFT, REGIONAL-VARIATION, MORTALITY, GENDER, SURGERY, WOMEN, TRIAL, SURVEILLANCE, PERFORMANCE",

author = "O'Donnell, {Thomas F X} and Verhagen, {Hence J} and Giovanni Pratesi and Carlo Pratesi and Teijink, {Joep A W} and Vermassen, {Frank E G} and Patrice Mwipatayi and Forbes, {Thomas L} and Schermerhorn, {Marc L}",

year = "2020",

month = apr,

doi = "10.1016/j.jvs.2019.05.065",

language = "English",

volume = "71",

pages = "1179--1189",

journal = "Journal of Vascular Surgery",

issn = "0741-5214",

publisher = "Elsevier",

number = "4",

}

O'Donnell, TFX, Verhagen, HJ, Pratesi, G, Pratesi, C, Teijink, JAW, Vermassen, FEG, Mwipatayi, P, Forbes, TL & Schermerhorn, ML 2020, 'Female sex is associated with comparable 5-year outcomes after contemporary endovascular aneurysm repair despite more challenging anatomy', Journal of Vascular Surgery, vol. 71, no. 4, pp. 1179-1189. https://doi.org/10.1016/j.jvs.2019.05.065

TY - JOUR

T1 - Female sex is associated with comparable 5-year outcomes after contemporary endovascular aneurysm repair despite more challenging anatomy

AU - O'Donnell, Thomas F X

AU - Verhagen, Hence J

AU - Pratesi, Giovanni

AU - Pratesi, Carlo

AU - Teijink, Joep A W

AU - Vermassen, Frank E G

AU - Mwipatayi, Patrice

AU - Forbes, Thomas L

AU - Schermerhorn, Marc L

PY - 2020/4

Y1 - 2020/4

N2 - BACKGROUND: Women with abdominal aortic aneurysms less often meet anatomic criteria for endovascular repair and experience worse perioperative and long-term survival.METHODS: We compared long-term survival, aneurysm-related mortality, and rates of endoleaks and reinterventions between male and female patients in the Endurant Stent Graft Natural Selection Global Postmarket Registry (ENGAGE) using 2:1 propensity score matching.RESULTS: There were 1130 male patients and 133 female patients, yielding 399 patients after matching (266 male patients, 133 female patients). Female patients were older, with smaller aneurysms, smaller iliac arteries, and shorter, more angulated necks, and they were more often treated outside the device instructions for use (all P < .001). Through 5 years, female patients experienced overall mortality comparable to that of well-matched male patients (34% vs 38%, respectively; hazard ratio, 0.89 [0.61-1.29]; P = .54) and lower aneurysm-related mortality (0% vs 3%; P = .047). Female patients experienced higher rates of any postoperative type IA endoleak through 5 years (10% vs 1%; P < .001) but comparable rates of secondary endovascular procedures (14% vs 16%; P = .40). Female sex was independently associated with significantly higher risk of long-term type IA endoleaks (hazard ratio, 4.8 [1.2-20.8]; P = .04), even after accounting for anatomic factors. No female patient experienced aneurysm rupture during follow-up, and only one female patient underwent conversion to open repair.CONCLUSIONS: Despite more challenging anatomy, female patients in the ENGAGE registry had long-term outcomes comparable to those of male patients. However, female patients experienced higher rates of type IA endoleaks. Although standard endovascular aneurysm repair remains a viable solution for most women, whether high-risk patients may be better served with open surgery, custom-made devices, EndoAnchors (Aptus Endosystems, Sunnyvale, Calif), or chimneys is worthy of further study.

AB - BACKGROUND: Women with abdominal aortic aneurysms less often meet anatomic criteria for endovascular repair and experience worse perioperative and long-term survival.METHODS: We compared long-term survival, aneurysm-related mortality, and rates of endoleaks and reinterventions between male and female patients in the Endurant Stent Graft Natural Selection Global Postmarket Registry (ENGAGE) using 2:1 propensity score matching.RESULTS: There were 1130 male patients and 133 female patients, yielding 399 patients after matching (266 male patients, 133 female patients). Female patients were older, with smaller aneurysms, smaller iliac arteries, and shorter, more angulated necks, and they were more often treated outside the device instructions for use (all P < .001). Through 5 years, female patients experienced overall mortality comparable to that of well-matched male patients (34% vs 38%, respectively; hazard ratio, 0.89 [0.61-1.29]; P = .54) and lower aneurysm-related mortality (0% vs 3%; P = .047). Female patients experienced higher rates of any postoperative type IA endoleak through 5 years (10% vs 1%; P < .001) but comparable rates of secondary endovascular procedures (14% vs 16%; P = .40). Female sex was independently associated with significantly higher risk of long-term type IA endoleaks (hazard ratio, 4.8 [1.2-20.8]; P = .04), even after accounting for anatomic factors. No female patient experienced aneurysm rupture during follow-up, and only one female patient underwent conversion to open repair.CONCLUSIONS: Despite more challenging anatomy, female patients in the ENGAGE registry had long-term outcomes comparable to those of male patients. However, female patients experienced higher rates of type IA endoleaks. Although standard endovascular aneurysm repair remains a viable solution for most women, whether high-risk patients may be better served with open surgery, custom-made devices, EndoAnchors (Aptus Endosystems, Sunnyvale, Calif), or chimneys is worthy of further study.

KW - Abdominal aortic aneurysm

KW - Sex

KW - Endovascular aneurysm repair

KW - Gender

KW - EVAR

KW - ABDOMINAL AORTIC-ANEURYSM

KW - ENDURANT STENT GRAFT

KW - REGIONAL-VARIATION

KW - MORTALITY

KW - GENDER

KW - SURGERY

KW - WOMEN

KW - TRIAL

KW - SURVEILLANCE

KW - PERFORMANCE

U2 - 10.1016/j.jvs.2019.05.065

DO - 10.1016/j.jvs.2019.05.065

M3 - Article

C2 - 31477480

SN - 0741-5214

VL - 71

SP - 1179

EP - 1189

JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

IS - 4

ER -

Female sex is associated with comparable 5-year outcomes after contemporary endovascular aneurysm repair despite more challenging anatomy

Abstract

Keywords

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