title: Evolution of gender-related differences in outcomes from two decades of endovascular aneurysm repair.
abstract: OBJECTIVE
  Women have been under-represented in trials that set guidelines for the management of aortic aneurysms. Several studies reported inferior outcomes in women compared with men after endovascular aneurysm repair (EVAR). We investigated the relationship between gender and outcomes after EVAR.
  
  
  METHODS
  A total of 1380 consecutive patients underwent elective EVAR from 1992 to 2012. Baseline, intraoperative, and postoperative variables by gender were analyzed from a prospective database.
  
  
  RESULTS
  The cohort comprised 214 women (15.5%) and 1166 men (84.5%). Women were older than men at repair (77.8 vs 74.5 years, P < .001) and had less cardiac disease (P = .005). They had shorter (19.8 ± 12.9 vs 26.3 ± 14.7 mm; P < .001) more angulated aortic necks (38.8° ± 16.1° vs 31.2° ± 14.7°; P < .001) and fewer iliac aneurysms (P = .002). Women had more arterial reconstructions (iliac conduits, P = .006; thrombolysis and thrombectomy, P = .013; patch angioplasty, P < .001; endarterectomy, P < .001), more perioperative complications (16.9% vs 9.1%; P = .001), and more in-hospital days (4.1 vs 3.4 days; P = .029). Perioperative mortality was equivalent (women: 2% vs men: 2.3%; P = .73). Mean follow-up was 30.9 months. Women and men experienced equivalent aneurysm-related deaths and overall survival. Survival curve analysis showed endoleaks were more likely to develop in women than men (P = .005); however, there was no difference in rates of arterial reinterventions required for each gender during the follow-up period.
  
  
  CONCLUSIONS
  Female gender is associated with more periprocedural complications, adjunctive arterial procedures, and increased endoleaks but does not affect long-term reinterventions or survival. Further studies are warranted to elucidate the effect of gender on outcomes. These data should be considered when selecting EVAR for men and women.
authors.affiliation: Division of Vascular Surgery, Mount Sinai Hospital, New York, NY.
authors.forename: Christine
authors.initials: C
authors.lastname: Chung
authors.affiliation: Division of Vascular Surgery, Mount Sinai Hospital, New York, NY.
authors.forename: Rami
authors.initials: R
authors.lastname: Tadros
authors.affiliation: Division of Vascular Surgery, Mount Sinai Hospital, New York, NY.
authors.forename: Marielle
authors.initials: M
authors.lastname: Torres
authors.affiliation: Division of Vascular Surgery, Mount Sinai Hospital, New York, NY.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Malik
authors.affiliation: Division of Vascular Surgery, Mount Sinai Hospital, New York, NY.
authors.forename: Sharif
authors.initials: S
authors.lastname: Ellozy
authors.affiliation: Division of Vascular Surgery, Mount Sinai Hospital, New York, NY.
authors.forename: Peter
authors.initials: P
authors.lastname: Faries
authors.affiliation: Division of Vascular Surgery, Mount Sinai Hospital, New York, NY.
authors.forename: Michael
authors.initials: M
authors.lastname: Marin
authors.affiliation: Division of Vascular Surgery, Mount Sinai Hospital, New York, NY. Electronic address: ageliki.vouyouka@mountsinai.org.
authors.forename: Ageliki G
authors.initials: AG
authors.lastname: Vouyouka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D016208:Databases, Factual; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D018579:Patient Selection; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome