Moacdieh Munir Paul, Zarrintan Sina, Janssen Claire B, Yei Kevin S, Patel Rohini J, Gaffey Ann C, Malas Mahmoud B
Division of Vascular & Endovascular Surgery, Department of Surgery, UC San Diego, La Jolla, CA; Center for Learning and Excellence in Vascular and Endovascular Research, UC San Diego, La Jolla, CA.
Division of Vascular & Endovascular Surgery, Department of Surgery, UC San Diego, La Jolla, CA; Center for Learning and Excellence in Vascular and Endovascular Research, UC San Diego, La Jolla, CA.
Ann Vasc Surg. 2025 Mar;112:344-351. doi: 10.1016/j.avsg.2024.12.043. Epub 2024 Dec 27.
There is a paucity of data on sex-based differences in outcomes after thoracic endovascular aortic repair (TEVAR) performed for Stanford type B aortic dissections (TBADs). Examining the predictive role of sex could shape future clinical guidelines for TEVAR. Thus, this study aims to evaluate the association between sex and postoperative outcomes after TEVAR performed for TBAD.
This is a retrospective cohort study utilizing the Vascular Quality Initiative from 2011 to 2024. We included all patients undergoing TEVAR for TBAD with entry tear zones > zone 0. Patients who presented with rupture, had a history of connective tissue disease and underwent conversion to open repair were excluded. Primary outcomes were 30-day mortality, postoperative stroke, myocardial infarction (MI), spinal cord ischemia (SCI), aorta-related reintervention and access-related reintervention. The secondary outcome was freedom from all-cause mortality (ACM) at 1 year.
A total of 5,117 patients underwent TEVAR for TBAD, of which 1,553 (30.3%) were women. Female patients were more likely to have a smaller aortic diameter compared to male patients (42.8 ± 11.5 vs. 45.8 ± 14.3; P < 0.001). After adjusting for potential confounders, there were no significant differences in 30-day mortality, stroke, MI, SCI, and aorta-related. reintervention between male and female patients. However, female patients were significantly more likely to undergo postoperative access-related reintervention (adjusted odds ratio = 2.4 [95% confidence interval [CI]: 1.1-5.0]; P = 0.023) compared to male patients. Freedom from ACM at 1 year was similar between males and females (adjusted hazard ratio = 1 [95% CI: 0.8-1.2]; P = 0.955).
In this study using large, real-world data, female patients undergoing TEVAR for TBAD showed an increased risk of postoperative access-related reintervention, possibly due to smaller access vessel diameter. Development of devices that better fit female anatomy may help mitigate these risks in the future.
关于 Stanford B 型主动脉夹层（TBAD）行胸主动脉腔内修复术（TEVAR）后基于性别的预后差异的数据较少。研究性别在其中的预测作用有助于形成未来 TEVAR 的临床指南。因此，本研究旨在评估 TBAD 行 TEVAR 术后性别与术后预后之间的关联。
这是一项回顾性队列研究，利用了 2011 年至 2024 年的血管质量倡议数据。我们纳入了所有因 TBAD 行 TEVAR 且入口撕裂区域>0 区的患者。排除出现破裂、有结缔组织病病史以及转为开放修复的患者。主要结局为 30 天死亡率、术后卒中、心肌梗死（MI）、脊髓缺血（SCI）、主动脉相关再干预和入路相关再干预。次要结局为 1 年时的全因死亡率（ACM）自由。
共有 5117 例患者因 TBAD 行 TEVAR，其中 1553 例（30.3%）为女性。与男性患者相比，女性患者的主动脉直径更可能较小（42.8±11.5 对 45.8±14.3；P<0.001）。在调整潜在混杂因素后，男性和女性患者在 30 天死亡率、卒中、MI、SCI 和主动脉相关再干预方面无显著差异。然而，与男性患者相比，女性患者术后更可能接受入路相关再干预（调整后的优势比=2.4[95%置信区间[CI]：1.1 - 5.0]；P = 0.023）。男性和女性在 1 年时的 ACM 自由情况相似（调整后的风险比=1[95%CI：0.8 - 1.2]；P = 0.955）。
在这项使用大型真实世界数据的研究中，因 TBAD 行 TEVAR 的女性患者术后入路相关再干预风险增加，可能是由于入路血管直径较小。开发更适合女性解剖结构的器械可能有助于未来降低这些风险。
