Manchella Mohit K, Rastogi Vinamr, Gaston Brandon, Kermani Shaghayegh S, Zacharias Nikolaos, Bellomo Tiffany R, Dua Anahita
Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA.
Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
J Vasc Surg. 2025 Sep;82(3):751-759.e5. doi: 10.1016/j.jvs.2025.05.011. Epub 2025 May 13.
This study aimed to investigate if benefits in patient outcomes conferred by endovascular repair compared with open repair of complex abdominal aortic aneurysms (cAAA) are maintained across genders. We undertook a comparative analysis of perioperative outcomes between open repair and fenestrated endovascular repair (FEVAR) using the Cook Zenith Fenestrated (ZFEN) graft for cAAAs.
A retrospective cohort study was conducted using data from the National Surgical Quality Improvement Program registry, including patients who underwent open repair or ZFEN for cAAA between 2011 and 2022. The study population stratified by sex included 1697 males and 663 females. Perioperative outcomes such as mortality, complications, and reoperation rates were analyzed using inverse probability weighting and logistic regression to adjust for confounding indications for surgery.
Among males, those undergoing ZFEN had significantly lower odds of major complications (14% vs 28%; adjusted odds ratio [aOR]. 0.43; P < .001), reoperation (6.0% vs 12%; aOR, 0.46; P = .03), and major respiratory complications (5.5% vs 12%; aOR, 0.42; P = .02) compared with open repair. In females, the trend toward fewer major complications with ZFEN (19% vs 31%; aOR, 0.50; P = .06) did not attain statistical significance. When comparing males with females undergoing open repair, males had 6.7 times higher odds of myocardial infarction and 16.0 times higher odds of wound complications compared with females. Conversely, females undergoing ZFEN had higher odds of reoperation compared with males (12% vs 4.1%; aOR, 0.13; P = .012).
This study highlights significant sex-specific differences in outcomes after both ZFEN and open repair for cAAA. ZFEN offers notable advantages in reducing complications for male patients, while its benefits are less pronounced in females. These findings underscore the need for tailored treatment strategies and further research to optimize outcomes for female patients undergoing aortic aneurysm repair.
本研究旨在调查与开放性修复相比，血管腔内修复复杂腹主动脉瘤（cAAA）所带来的患者预后益处是否在不同性别中均能维持。我们使用库克公司的齐尼斯开窗（ZFEN）移植物，对开放性修复与开窗血管腔内修复（FEVAR）治疗cAAA的围手术期结果进行了对比分析。
利用国家外科质量改进计划登记处的数据进行了一项回顾性队列研究，纳入了2011年至2022年间接受开放性修复或ZFEN治疗cAAA的患者。按性别分层的研究人群包括1697名男性和663名女性。使用逆概率加权法和逻辑回归分析调整手术的混杂指征，分析围手术期死亡率、并发症和再次手术率等结果。
在男性中，接受ZFEN治疗的患者发生严重并发症的几率显著较低（14%对28%；调整优势比[aOR]为0.43；P<0.001），再次手术几率（6.0%对12%；aOR为0.46；P = 0.03）以及严重呼吸并发症几率（5.5%对12%；aOR为0.42；P = 0.02）均低于开放性修复。在女性中，ZFEN治疗严重并发症较少的趋势（19%对31%；aOR为0.50；P = 0.06）未达到统计学显著性。在比较接受开放性修复的男性和女性时，男性发生心肌梗死的几率是女性的6.7倍，伤口并发症几率是女性的16.0倍。相反，接受ZFEN治疗的女性再次手术的几率高于男性（12%对4.1%；aOR为0.13；P = 0.012）。
本研究突出了cAAA接受ZFEN和开放性修复后在结局方面存在显著的性别差异。ZFEN在降低男性患者并发症方面具有显著优势，而在女性中的益处则不那么明显。这些发现强调了需要制定个性化的治疗策略，并进行进一步研究以优化接受主动脉瘤修复的女性患者的结局。
