Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Florida College of Medicine, Gainesville, FL.
Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Florida College of Medicine, Gainesville, FL.
J Vasc Surg. 2022 Nov;76(5):1198-1204.e1. doi: 10.1016/j.jvs.2022.06.088. Epub 2022 Jul 3.
Sex-based differences in outcomes for patients undergoing degenerative aortic aneurysm repair have been well described, with female patients having worse early and long-term outcomes compared with male patients. However, differences between men and women after thoracic endovascular aortic repair (TEVAR) of acute complicated type B aortic dissection (TBAD) have not been well characterized. Therefore, the objective of the present study was to assess the sex-based differences in clinical presentation, time to repair, morbidity, and mortality for patients undergoing TEVAR for TBAD.
All TEVAR procedures performed for acute complicated TBAD from a single academic medical center from August 2005 to January 2020 were analyzed. The clinical presentation, time to repair, and outcomes were compared by sex. The primary outcome was 30-day mortality. The secondary outcomes were in-hospital complications, reintervention, aorta-related death, and out of hospital survival. The predictors of mortality, including sex, were determined using multivariable logistic regression.
A total of 159 patients (38 women [24%]) were included in the analysis. No sex-based differences were found in clinical presentation or comorbidity prevalence between the female and male patients. The female patients had had a longer overall time from initial symptom onset to TEVAR (female patients: median, 3.5 days [interquartile range (IQR), 1-10 days]; male patients: median, 1 day [IQR, 1-3]; P = .007). However, no differences were found in the time to repair after admission to the academic medical center (female patients: median, 1 day [IQR, 0-5 days]; male patients: median, 1 day [IQR, 0-3]; P = .176). No differences were found in the unadjusted aortic-related, in-hospital, or 30-day death between the female and male patients. Similarly, the risk-adjusted analysis revealed that sex was not associated with adverse outcomes. The 1- and 5-year freedom from aortic-related mortality were 82% ± 4% and 87% ± 6% and 79% ± 4% and 80% ± 8% for the men and women, respectively.
We found no differences between the female and male patients with acute complicated TBAD who had undergone TEVAR in the clinical presentation or comorbidities. The female patients had undergone TEVAR after a longer duration of symptoms, but this was not associated with sex-based differences in early or late morbidity or mortality.
已有研究充分描述了接受退行性主动脉瘤修复术的患者在结局方面的性别差异，与男性患者相比，女性患者的早期和长期结局更差。然而，女性和男性在接受胸主动脉腔内修复术（TEVAR）治疗急性复杂型 B 型主动脉夹层（TBAD）后的差异尚未得到充分描述。因此，本研究旨在评估接受 TEVAR 治疗急性复杂型 TBAD 的患者在临床表现、修复时间、发病率和死亡率方面的性别差异。
分析了 2005 年 8 月至 2020 年 1 月期间，来自单一学术医疗中心的所有接受 TEVAR 治疗的急性复杂型 TBAD 病例。通过性别比较临床表现、修复时间和结局。主要结局为 30 天死亡率。次要结局包括院内并发症、再次干预、与主动脉相关的死亡和院外生存率。使用多变量逻辑回归确定死亡率的预测因素，包括性别。
共纳入 159 例患者（38 例女性[24%]）进行分析。女性和男性患者在临床表现或合并症患病率方面无性别差异。女性患者从最初症状发作到 TEVAR 的总时间更长（女性患者：中位数 3.5 天[四分位距（IQR），1-10 天]；男性患者：中位数 1 天[IQR，1-3 天]；P =.007）。然而，从入院到接受学术医疗中心治疗的修复时间无差异（女性患者：中位数 1 天[IQR，0-5 天]；男性患者：中位数 1 天[IQR，0-3 天]；P =.176）。女性和男性患者的主动脉相关、院内或 30 天死亡率无差异。同样，风险调整分析显示，性别与不良结局无关。男性和女性患者的 1 年和 5 年免于主动脉相关死亡率分别为 82%±4%和 87%±6%和 79%±4%和 80%±8%。
我们发现，接受 TEVAR 治疗的急性复杂型 TBAD 女性和男性患者在临床表现或合并症方面无差异。女性患者的症状持续时间较长，但这与性别之间的早期或晚期发病率或死亡率无差异无关。
