Mwipatayi Bibombe P, Anwari Tahmina, Wong Jackie, Verhoeven Eric, Dubenec Steven, Heyligers Jan M, Milner Ross, Mascoli Chiara, Gargiulo Mauro, Shutze William P
Department of Vascular Surgery, Royal Perth Hospital, Perth, Australia; Faculty of Medicine, School of Surgery, Dentistry and Health Sciences, University of Western Australia, Perth, Australia.
Department of Vascular Surgery, Royal Perth Hospital, Perth, Australia.
Ann Vasc Surg. 2020 Aug;67:242-253.e4. doi: 10.1016/j.avsg.2020.02.014. Epub 2020 Mar 16.
Abdominal aortic aneurysms (AAAs) are more common in men. However, women have been shown to have more short- and long-term adverse outcomes after endovascular aneurysm repair. This disparity is thought to be multifactorial, including anatomical differences, hormonal differences, older age of presentation, and a greater degree of preoperative comorbidities.
A retrospective analysis that included data for 3,758 patients from the Global Registry for Endovascular Aortic Treatment (GREAT) was conducted. Patients were recruited into GREAT between August 2010 and October 2016 and received the Gore Excluder stent graft for infrarenal AAAs repair. Cox multivariate regression analyses were performed to analyze any reintervention and device-related intervention rates.
Of the 3,758 patients, 3,220 were male (mean age 73 years) and 538 were female (mean age 75 years). Women had higher prevalence rates of chronic obstructive pulmonary disease (P < 0.0001) and renal insufficiency (P = 0.03), whereas men had higher rates of cardiovascular comorbidities. The AAAs in women were smaller in diameter with shorter and more angulated necks. Women did not experience a significantly higher rate of endoleaks but did exhibit higher reintervention rates, including reintervention for device-related issues. In terms of mortality, aorta-related mortality was most prevalent within the first 30 days after procedure in both sexes.
Women were treated at an older age and had a more hostile aneurysmal anatomy. Although the mortality rates were lower in women, they had significantly higher rates of reintervention, and thus higher morbidity rates after endovascular aneurysm repair.
腹主动脉瘤（AAA）在男性中更为常见。然而，血管内动脉瘤修复术后，女性的短期和长期不良结局更多。这种差异被认为是多因素的，包括解剖学差异、激素差异、就诊时年龄较大以及术前合并症程度较高。
进行了一项回顾性分析，纳入了全球血管内主动脉治疗注册研究（GREAT）中3758例患者的数据。2010年8月至2016年10月期间，患者被纳入GREAT，并接受了用于肾下腹主动脉瘤修复的戈尔封堵型覆膜支架。进行Cox多变量回归分析，以分析任何再次干预和与器械相关的干预率。
在3758例患者中，3220例为男性（平均年龄73岁），538例为女性（平均年龄75岁）。女性慢性阻塞性肺疾病（P < 0.0001）和肾功能不全（P = 0.03）的患病率较高，而男性心血管合并症的患病率较高。女性的腹主动脉瘤直径较小，颈部较短且角度更大。女性内漏发生率没有显著更高，但再次干预率更高，包括因器械相关问题进行的再次干预。在死亡率方面，两性在术后30天内主动脉相关死亡率最为普遍。
女性接受治疗时年龄较大，动脉瘤解剖结构更复杂。尽管女性死亡率较低，但血管内动脉瘤修复术后，她们的再次干预率显著更高，因此发病率也更高。
