New data in the July 2011 issue of the Journal of Vascular Surgery compares the effects of gender on long-term survival in different types of abdominal aortic aneurysm repair.
Researchers from Mount Sinai School of Medicine and Columbia University Medical Center in New York City, and the University of Wisconsin in Madison, used the Medicare Beneficiary Database (1995-2006) to analyse survival in cohorts of patients. They evaluated data for patients who underwent open aneurysm repair (OAR) or endovascular aneurysm repair (EVAR) for 322,892 elective abdominal aortic aneurysm and 48,865 ruptured abdominal aortic aneurysms. Men and women were matched by propensity scores, accounting for baseline demographics, co-morbid conditions, treating institution and surgeon experience. Frailty models were used to compare long-term survival.
Perioperative mortality for elective abdominal aortic aneurysms was significantly lower among EVAR vs. OAR recipients for men (1.84% vs. 4.80%) and women (3.19% vs. 6.37%) according to co-author Natalia N Egorova, assistant professor of health evidence and policy at Mount Sinai School of Medicine. “One difference was that the survival benefit of EVAR was sustained for the 6 years of follow-up in women but disappeared in 2 years in men,” said Egorova. “Similarly, the survival benefit of men vs. women after elective EVAR disappeared after 1.5 to 2 years.”
Angeliki G Vouyouka, assistant professor of the division of vascular surgery at Mount Sinai Hospital, added that for ruptured abdominal aortic aneurysms, 30-day mortality was significantly lower for EVAR recipients compared with OAR recipients, for both men (33.43% vs. 43.70%) and women (41.01% vs. 48.28%). Six-year survival was significantly higher for men who received EVAR vs. those who received OAR. There was also a subtle survival benefit for women who received EVAR compared with OAR that was evident only in procedures performed in the very recent years however this benefit disappeared in 6 months. Survival was also substantially higher for men than women after emergent EVAR for ruptured abdominal aortic aneurysm.
“Gender disparity is evident from long-term outcomes after abdominal aortic aneurysm repair,” said Egorova. “In the case for ruptured abdominal aortic aneurysms, where the long-term outcome for women was significantly worse than for men, the less invasive EVAR treatment did not appear to benefit women to the same extent that it did for men. On a positive note in elective conditions, the survival benefit of EVAR versus open repair for women was sustained longer than for men. These associations require further study to isolate specific risk factors that would be potential targets for improving abdominal aortic aneurysm management.”