Gender and perioperative outcomes after fenestrated endovascular repair using custom-made and off-the-shelf devices.
BACKGROUND
The role of gender on perioperative outcomes after fenestrated endovascular aortic aneurysm repair (FEVAR) has not been established. The aim of this study is to determine the effect of gender on perioperative outcomes after FEVAR for complex abdominal aortic aneurysms using premanufactured devices.


METHODS
During a 2-year period, 79 patients (63 men [80%] and 16 women [20%]) underwent FEVAR using Zenith Fenestrated AAA Endovascular Grafts, investigational Zenith pivot branch (p-branch) devices and fenestrated custom-made devices. A single-institutional study was performed to evaluate postoperative outcomes after FEVAR. The χ2, Fisher's, and nonparametric tests were used for bivariate analysis. Logistic regression was used for multivariate analysis.


RESULTS
Median age was 73 years (interquartile range [IQR], 68-79 years). The median number of fenestrations was three. There was no difference in aneurysm anatomic location, size, or number of fenestrations between patients in either group. Women were more likely to undergo endoconduits at the access site before the target procedure (19% vs 2%; P = .02). The overall postoperative complication rate was similar among females and males (31% vs 33%; P > .5). However, women experienced longer times in the intensive care unit (median, 3 days [IQR, 2-5] vs 2 [IQR, 1-3]; P = .05) and longer duration of hospital stay (median, 4.5 days [IQR, 3-6.5] vs 3 [IQR, 2-4]; P < .01). Similarly, the rate of reinterventions was higher among women, 25% vs 5% (P = .02). For renal adverse events, there was a trend for a higher rate of renal function deterioration based in creatinine levels among women, when compared with men (18% vs 5%; P = .09). Multivariate analysis showed that female gender was associated with a 8-fold increased risk of renal function deterioration (odds ratio, 8.1; 95% confidence interval, 6.1-10.8). Female gender was also identified as in independent factor for reinterventions at 30 days (odds ratio, 7.4; 95% confidence interval, 6.7-8.1).


CONCLUSIONS
FEVAR is a safe and effective procedure for patients at high and standard risk for open repair who are not eligible for standard EVAR. Women are at greater risk for more severe renal function deterioration, early reinterventions and longer durations of hospital and intensive care unit stay.
Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Tex. Electronic address: david.timaran@utsouthwestern.edu.
David E
DE
Timaran
Division of Vascular Surgery, University of North Carolina-Health Care, Chapel Hill, NC.
Martyn
M
Knowles
Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Tex.
Marilisa
M
Soto-Gonzalez
Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Tex.
J Gregory
JG
Modrall
Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Tex.
Shirling
S
Tsai
Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Tex.
Melissa
M
Kirkwood
Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Tex.
John
J
Rectenwald
Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Tex.
Carlos H
CH
Timaran
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D016009:Chi-Square Distribution; D016208:Databases, Factual; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D011474:Prosthesis Design; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D015607:Stents; D013781:Texas; D013997:Time Factors; D016896:Treatment Outcome