Department of Surgery, Division of Vascular Surgery at Emory University School of Medicine, Atlanta, GA 30322, USA.
J Vasc Surg. 2011 Sep;54(3):669-75; discussion 675-6. doi: 10.1016/j.jvs.2011.03.010. Epub 2011 Jun 12.
Unlike with abdominal aortic aneurysms (AAA), women appear to have an almost comparable incidence as men for thoracic aortic aneurysms (TAA). However, the extent to which a patient's sex influences endograft treatment of TAA has not been reported. The current study analyzes the influence of sex on the endovascular management of TAAs.
A total of 421 patients (265 men and 156 women) were identified as part of the TAG (W. L. Gore and Associates, Flagstaff, Ariz) thoracic stent graft trials. Preoperative risk factors, intraoperative events, and 365-day follow-up data were analyzed.
Among 18 different preoperative risk factors evaluated, women were less likely to have prior vascular procedures (38.9% vs 55.3%; P = .004). A trend was noted toward lower rates of coronary artery disease (41.3% vs 51.2%; P = .09) and smoking (77.8% vs 85.6%; P = .08). Women were also more likely to be nonwhite (81.4% vs 87.9%; P = .007). Women had a smaller mean external iliac vessel diameter (7.1 vs 9.0 mm; P < .001), resulting in 24.4% vs 6.0% conduit use (P < .001) for device delivery. Local access site complications were significantly higher in women (14.1% vs 4.5%; P < .001). No difference was noted between sexes in the technical success rate (device delivery and successful aneurysm exclusion) or the major adverse event rate at 30 days (26.3% vs 20.4%; P = .18). The overall length of stay was 5.5 ± 6.2 days for female patients vs 4.8 ± 13.0 days (P < .001). No sex-related difference was noted in endoleak rate, aneurysm rupture, prosthetic migration, or aneurysm diameter change at 365 days.
No significant differences in major outcomes were noted between men and women treated with endovascular repair of TAA at 1 month and 1 year. Women have more vascular complications, which are associated with smaller access vessels. A lower threshold for using conduits in women may be a more prudent approach.
与腹主动脉瘤（AAA）不同，女性患胸主动脉瘤（TAA）的发病率与男性几乎相当。然而，患者的性别对 TAA 腔内治疗的影响程度尚未报道。本研究分析了性别对 TAA 腔内治疗的影响。
共有 421 名患者（265 名男性和 156 名女性）被确定为 TAG（W. L. Gore and Associates，Flagstaff，Ariz）胸主动脉支架移植物试验的一部分。分析了术前危险因素、术中事件和 365 天随访数据。
在评估的 18 个不同的术前危险因素中，女性接受过血管内操作的比例较低（38.9%比 55.3%；P=0.004）。有较低的冠心病发生率（41.3%比 51.2%；P=0.09）和吸烟率（77.8%比 85.6%；P=0.08）的趋势。女性也更有可能是非白人（81.4%比 87.9%；P=0.007）。女性的平均髂外血管直径较小（7.1 毫米比 9.0 毫米；P<0.001），导致输送装置时管腔的使用率分别为 24.4%和 6.0%（P<0.001）。女性局部入路并发症发生率显著较高（14.1%比 4.5%；P<0.001）。男女之间在技术成功率（装置输送和成功排除动脉瘤）或 30 天主要不良事件发生率（26.3%比 20.4%；P=0.18）方面无差异。女性的平均住院时间为 5.5±6.2 天，而男性为 4.8±13.0 天（P<0.001）。在 365 天时，内漏率、动脉瘤破裂、移植物迁移或动脉瘤直径变化方面未观察到与性别相关的差异。
在接受 TAA 血管内修复的男性和女性中，1 个月和 1 年时主要结局无显著差异。女性血管并发症更多，与较小的入路血管有关。在女性中使用管腔的阈值较低可能是一种更谨慎的方法。
