Sex-related Outcomes After Thoracic Endovascular Repair For Intact Isolated Descending Thoracic Aortic Aneurysm
Sara Allievi, MD1, Vinamr Rastogi, MD1, Sai Divya Yadavalli, MD1, Sarah E. Deery, MD2, Ruby C Lo, MD3, Hence J.M. Verhagen, MD, PhD4, Santi Trimarchi, MD, PhD5, Marc L. Schermerhorn, MD1.
1Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA, 2Division of Vascular Surgery, Maine Medical Center, Portland, ME, USA, 3Department of Surgery, Division of Vascular Surgery, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI, USA, 4Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, Netherlands, 5Department of Vascular Surgery, Fondazione IRCCS Cą Granda Ospedale Maggiore Policlinico, Milan, Italy.
OBJECTIVE - Several studies have reported conflicting results regarding sex-related outcomes following TEVAR, and data regarding long-term sex-related outcomes are limited. This study aims to evaluate the association between sex and perioperative as well as long-term outcomes after TEVAR for intact isolated descending thoracic aortic aneurysms (iiDTAA).
METHODS - We included all patients who underwent TEVAR between 2014-2019 for iiDTAA in VQI linked to Medicare claims. Patients with thoracoabdominal, synchronous, or metachronous aneurysm were excluded. We assessed perioperative mortality and complications with univariable analysis, and 5-year mortality, reinterventions and ruptures of the thoracic aorta, with Kaplan-Meier methods and multivariable Cox regression analysis. RESULTS - We identified 705 patients (54% females) who underwent TEVAR for iiDTAA. Compared with males, females were slightly older (age: 75.9 years [±7.7] vs. 75.4 years [±7.9]), and less frequently presented with history of coronary artery disease (all p<.05). Between sexes, mean aortic diameters were similar (56.5 mm [±13.2] vs. 57.2 mm [±14.9], p=.75), but females more frequently were symptomatic (33% vs. 23%, p=.004). Females were more likely to be transfused >2 units of packed red blood cells (19% vs. 14%, p=.060), and to have longer total procedure time (112 min [IQR 74-169] vs. 97 min [IQR 67-142], p=.001). Despite this, perioperative mortality was not significantly different between sexes (3.7% in females vs. 2.2% in males, p=.34), as were rates for any complication as composite outcome (20.2% vs. 16.4%, p=1), as well as for independent complications (all p>.05). Furthermore, following univariable analysis, compared with males, females had similar rates of 5-year mortality (32% vs. 31%, Hazard Ratio [HR]: 0.99 [95% Confidence Interval (CI)]: 0.76-1.29, p=.092), reintervention (11.7% vs. 12.5%, HR: 1.02. [95% CI: 0.67-1.54], p=.94) and late ruptures (2.1% vs. 1.5%, HR: 0.87 [95% CI]: 0.12-6.15 p=.89). Following multivariable analysis, outcomes remained similar at these time points (Figure).
CONCLUSIONS - Our findings suggest that females who undergo TEVAR for iiDTAA have similar outcomes as compared to males. Therefore, our data suggest that females are not at higher risk of developing adverse outcomes after TEVAR for iiDTAA. 
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