Gender-based Outcomes Of Endovascular Treatment For Popliteal Arterial Aneurysms Repairs: An 8-year Review Of National Data
Nallely Saldana-Ruiz, MD, MPH, Gregory Magee, MD MSc, Kenneth Ziegler, MD, Sukgu M. Han, Fred A. Weaver, MD, Vincent L. Rowe, MD.
University of Southern California, Los Angeles, CA, USA.
OBJECTIVES: Series of popliteal artery aneurysms (PAA) report up that up to a 5% of PAAs occur in women, with disproportionately higher rates of aneurysm- related morbidity and mortality. We examine national treatment trends and clinical outcomes of endovascular PAA repairs in U.S. women using a large, prospectively collected, national dataset.
METHODS: : We identified all PAA patients who underwent an endovascular peripheral vascular intervention (PVI) in the Vascular Quality Initiative (VQI) national database from 2010-2018. Our primary outcomes were mortality, patency and amputation at 12-month follow-up using x2and t-test statistics for categorical and continuous variables respectively.
RESULTS: A total of 1,030 popliteal aneurysm endovascular repairs were conducted. Repair in women accounted for 3.6%, men 96.4%. Mean age of men was 72.9 +/- 10.3, women 75.6+/-10.3 (P=0.12). There was no differences in race, age, insurance, urgency, procedure setting aneurysm diameter, fluoroscopy time, ambulatory status, prior amputations, coronary artery disease, congestive heart failure, dysrhythmia, chronic obstructive pulmonary disease, diabetes, dialysis, use of aspirin, p2y12 inhibitors, by sex (P>0.05). Women were more likely to come from a nursing home, take ACE inhibitors and anticoagulation and have a history of cerebrovascular disease (P<0.05). Women had more non-femoral access (P=0.0004) and shorter vessel length treated of (P=0.05). Primary outcomes of mortality, patency and amputation did not differ by sex(P>0.05), compared to men. Secondary outcomes of post-operative cardiac, pulmonary and renal complications as well as access site related complications of re-intervention, thrombosis, embolism or hematoma also did not differ by sex(P>0.05).
CONCLUSIONS: PAA are uncommon among women, with endovascular repairs accounting for only 3.6% of all endovascular popliteal artery aneurysm repairs. Despite a more challenging access for women undergoing endovascular repairs, important clinical outcomes of mortality, patency and amputation are comparable to that of men at 12-month follow-up.
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