title: Late mortality in females after endovascular aneurysm repair.
abstract: BACKGROUND
  Abdominal aortic aneurysm (AAA) rupture is an adverse arterial remodeling event with high mortality risk. Because females have increased rupture risk with smaller AAAs (<5.5 cm), many recommend elective repair before the AAA reaches 5.5 cm. Elective repair improves survival for large AAAs, but long-term benefits of endovascular aneurysm repair (EVAR) for small AAAs in females remain less understood. The objective of this study was to identify if differences in late mortality exist between females undergoing elective EVAR at our institution for small and/or slow-growing AAAs compared with those who meet standard criteria.
  
  
  METHODS
  We retrospectively analyzed all patients that underwent EVAR for infrarenal AAA from June, 2009-June, 2013. We excluded patients that were male, treated emergently or for iliac artery aneurysm, and that received renal and/or mesenteric artery stenting. Patients did not meet anatomic criteria if preoperative AAA diameter was <5.5 cm or enlarged <0.5 cm over 6 mo. Late mortality was assessed from the social security death index.
  
  
  RESULTS
  Thirty-six of 162 elective EVAR patients (22.2%) were female (mean follow-up, 37.2 mo). Twenty patients (55.6%) met AAA size and/or growth criteria, whereas 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% versus 5%; P = 0.03) with a trend toward increased reoperation rate (25% versus. 5%; P = 0.48). Meeting size and/or growth criteria decreased odds of late death (odds ratio, 0.09; 95% confidence intervals, 0.01-0.83).
  
  
  CONCLUSIONS
  There is increased late mortality in females receiving elective EVAR at our institution for small and/or slow-growing AAAs. This late mortality may limit the benefits of EVAR for this population.
authors.affiliation: Department of Surgery, Emory University, Atlanta, GA. Electronic address: jepreis@emory.edu.
authors.forename: Joshua E
authors.initials: JE
authors.lastname: Preiss
authors.affiliation: Department of Surgery, Emory University, Atlanta, GA; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA; Surgical and Research Services, Atlanta VA Medical Center, Atlanta, GA.
authors.forename: Shipra
authors.initials: S
authors.lastname: Arya
authors.affiliation: Department of Surgery, Emory University, Atlanta, GA.
authors.forename: Yazan
authors.initials: Y
authors.lastname: Duwayri
authors.affiliation: Department of Surgery, Emory University, Atlanta, GA.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Shafii
authors.affiliation: Department of Surgery, Emory University, Atlanta, GA.
authors.forename: Ravi K
authors.initials: RK
authors.lastname: Veeraswamy
authors.affiliation: Department of Surgery, Emory University, Atlanta, GA.
authors.forename: Ravi R
authors.initials: RR
authors.lastname: Rajani
authors.affiliation: Department of Surgery, Emory University, Atlanta, GA.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Dodson
authors.affiliation: Department of Surgery, Emory University, Atlanta, GA; Surgical and Research Services, Atlanta VA Medical Center, Atlanta, GA.
authors.forename: Luke P
authors.initials: LP
authors.lastname: Brewster
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D057510:Endovascular Procedures / Q000401:mortality*; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006801:Humans; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies
keywords: Abdominal aortic aneurysm (AAA); Aneurysm diameter; Endovascular aneurysm repair (EVAR); Female; Mortality; Size threshold