Higher All-Cause but Not Aortic-Related Mortality for Women After Abdominal Aortic Aneurysm Repair

Abstract

Introduction: Sex-based disparities have been consistently reported after abdominal aortic aneurysm (AAA) repair. This single-center study aimed to identify whether this is a reproducible finding within our institution's cohort following AAA repair.

Methods: This is a single-center retrospective cohort study of patients with AAA who underwent surgical repair (open or endovascular) between 2014 and 2024. Primary outcomes were aortic-related complications at 30 d and mid-term follow-up. Secondary outcomes included reintervention and mortality. Propensity score matching based on age and procedure type was used to assess differences between sexes.

Results: A total of 152 patients were identified with 38 (25%) females. One hundred twelve (73.7%) patients underwent endovascular aneurysm repair, 20 (13.2%) fenestrated endovascular aneurysm repair, and 20 (13.2%) open aortic repairs. Female patients were found to be more hypertensive compared to male patients (females: 92.5%, males: 77.5%; P < 0.01). There were no differences in terms of aortic-related complications among sexes at 30 d (males: 1.8%, females: 2.6%; P = 1) and reinterventions (males: 1.8%, females: 2.6%; P = 1). At a mean follow-up of 2.6 ± 2.3 y, no difference was found between males and females regarding aortic-related complications (males: 13.2%, females: 13.2%; P = 1) or reinterventions (males: 12.3%, females: 7.9%; P = 0.56). All-cause mortality on follow-up was recorded in 20 (17.5%) of our male and 13 (34.2%) of our female patients (P = 0.031), with neoplastic and cardiac causes being the most common. Vascular-related mortality was not different between male and female patients (males: 0.9%, females: 2.6%; P = 0.44), with one death in each group.

Conclusions: While aortic-related complications and reinterventions did not differ between sexes, females had higher all-cause mortality during follow-up, driven by nonaortic causes. Therefore, an individualized sex-specific approach to patients with aortic disease should be the cornerstone for decision-making regarding intervention.

Keywords: Abdominal aortic aneurysm; Cohort study; Propensity score matching; Sex; Sex disparities; Surgery; Vascular surgery.