Late mortality in females after endovascular aneurysm repair

• Type of Material: Article
• Authors: Joshua E. Preiss, Emory University; Yazan Duwayri, Emory University; Ravi Rajani, Emory University; Thomas Dodson, Emory University; Shipra Arya, Emory University; Ravi Veeraswamy, Emory University; Luke Brewster, Emory University; Susan Shafii, Emory University
• Language: English
• Date: 2015-10-01
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2015 Elsevier Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jss.2015.04.003
• Title of Journal or Parent Work: Journal of Surgical Research
• ISSN: 0022-4804
• Volume: 198
• Issue: 2
• Start Page: 508
• End Page: 514
• Grant/Funding Information: In addition, Mr. Preiss’s time was supported by Emory School of Medicine’s Discovery research program.; Research support provided by NHLBI KO8HL119592 & Society for Vascular Surgery/American College of Surgeons Scientific Development Grant (LB), American Heart Award Innovative Research Grant IRG14740001 (LB), and Emory Department of Surgery Startup Funds (LB).
• Keywords: TRIAL; Life Sciences & Biomedicine; GENDER; UNITED-STATES; Aneurysm diameter; SURVEILLANCE; Mortality; Abdominal aortic aneurysm (AAA); Surgery; Female; Size threshold; Endovascular aneurysm repair (EVAR); OUTCOMES; PRACTICE GUIDELINES; Science & Technology; RISK-FACTORS
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Background: Abdominal aortic aneurysm (AAA) rupture is an adverse arterial remodeling event with high mortality risk. Since females have increased rupture risk with smaller AAAs (<5.5 cm), many recommend elective repair prior to 5.5 cm. Elective repair improves survival for large AAAs, but long-term benefits of endovascular aneurysm repair (EVAR) for small AAAs in females remains less understood. The objective of this study is to identify if differences in late mortality exist between females undergoing elective EVAR at our institution for small/slow-growing AAAs compared to those who meet standard criteria. Methods: We retrospectively analyzed all patients that underwent EVAR for infrarenal AAA from 6/2009–6/2013. We excluded patients that were male, treated emergently or for iliac artery aneurysm, and that received renal/mesenteric artery stenting. Patients did not meet anatomic criteria if preoperative AAA diameter was <5.5 cm or enlarged <0.5 cm over 6 months. Late mortality was assessed from the Social Security Death Index. Results: 36/162 (22.2%) elective EVAR patients were female (mean follow-up 37.2 months). 20 (55.6%) patients met AAA size/growth criteria while 16 (44.4%) did not meet criteria. Despite comparable demographics, comorbidities, and complications, patients that did not meet criteria had higher late mortality (37.5% vs. 5%; P= .03) with a trend towards increased reoperation rate (25% vs. 5%; P= .48). Meeting size/growth criteria decreased odds of late death (OR .09; 95% CI 0.01–0.83). Conclusion: There is increased late mortality in females receiving elective EVAR at our institution for small/slow-growing AAAs. This late mortality may limit the benefits of EVAR for this population.