Sex Influence on Fenestrated and Branched Endovascular Aortic Aneurysm Repair: Outcomes From a National Multicenter Registry

• Published in: Journal of endovascular therapy 2024-08, Vol.31 (4), p.697-705
• Main Authors: Isernia, Giacomo, Simonte, Gioele, Gallitto, Enrico, Bertoglio, Luca, Fargion, Aaron, Melissano, Germano, Chiesa, Roberto, Lenti, Massimo, Pratesi, Carlo, Faggioli, Gianluca, Gargiulo, Mauro, Luigi, Baccani, Luca, Bertoglio, Roberto, Chiesa, Gianluca, Faggioli, Aaron, Fargion, Cecilia, Fenelli, Gianluigi, Fino, Enrico, Gallitto, Mauro, Gargiulo, Giacomo, Isernia, Andrea, Kahlberg, Massimo, Lenti, Antonino, Logiacco, Chiara, Mascoli, Germano, Melissano, Andrea, Melloni, Gianpalolo, Reboldi, Gianbattista, Parlani, Rodolfo, Pini, Carlo, Pratesi, Enrico, Rinaldi, Gioele, Simonte, Sara, Speziali
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aortic Aneurysm, Abdominal - diagnostic imaging; Aortic Aneurysm, Abdominal - mortality; Aortic Aneurysm, Abdominal - surgery; Aortic Aneurysm, Thoracic - diagnostic imaging; Aortic Aneurysm, Thoracic - mortality; Aortic Aneurysm, Thoracic - surgery; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - instrumentation; Blood Vessel Prosthesis Implantation - mortality; Endovascular Procedures - adverse effects; Endovascular Procedures - mortality; Female; Health Status Disparities; Healthcare Disparities; Humans; Italy; Male; Middle Aged; Postoperative Complications - etiology; Prosthesis Design; Registries; Retrospective Studies; Risk Assessment; Risk Factors; Sex Factors; Stents; Time Factors; Treatment Outcome
• ISSN: 1526-6028; 1545-1550; 1545-1550
• DOI: 10.1177/15266028221137498

Introduction: Women are generally underrepresented in trials focusing on aortic aneurysm. Nevertheless, sex-related differences have recently emerged from several studies and registries. The aim of this research was to assess whether sex-related anatomical disparities existed in fenestrated and branched aortic repair candidates and whether these discrepancies could influence endovascular repair outcomes. Methods: Data from all consecutive patients treated during the 2008–2019 period within the Italian Multicenter fenestrated or branched endovascular aortic repair (F/BEVAR) Registry were included in the present study. Propensity matching was performed using a logistic regression model adjusted for demographic data and comorbidities to obtain comparable male and female samples. The selection model led to a final study population of 176 patients (88 women and 88 men) among the total initial cohort of 596. Study endpoints were technical and clinical success, overall survival, aneurysm-related death, and reintervention rates evaluated at 30 days and during follow-up. Results: Twenty-eight patients (15.9%) received urgent/emergent repair. In most of the cases (71.6%), women received treatment for extensive thoracoabdominal pathology (Crawford type I, II, or III aneurysm rather than type IV or juxta-pararenal) versus 46.6% of men (p=0.001). Female patients presented with more challenging iliac accesses with at least one side considered hostile in 27.3% of the cases (vs 13.6% in male patients, p=0.039). Finally, women had significantly smaller visceral vessels. Women had significantly worse operative outcomes, with an 86.2% technical success rate versus 96.6% in the male population (p=0.016). No differences were recorded in terms of 30-day reinterventions between men and women. The 5-year estimate of freedom from late reintervention, according to Kaplan-Meier analysis, was 85.6% in men versus 81.6% in women (p=ns). No aneurysm-related death was recorded during follow-up (median observational time, 23 months [interquartile range, 7–45 months]). Conclusion: Women presented a significantly higher incidence of thoracoabdominal aneurysms, smaller visceral vessels, and more complex iliofemoral accesses, resulting in a significantly lower technical success after F/BEVAR. Further studies assessing sex-related differences are needed to properly determine the impact on outcomes and stratify procedural risks. Clinical Impact Women are generally underrepresented in trials foc