Women with abdominal aortic aneurysm (AAA) were found to be 65% more likely than men to receive open surgical repair, and women treated with endovascular repair (EVR) had higher mortality rates than men, according to an article published in JAMA Network Open.
In this cohort study, the data from 16,386 individuals with AAA (mean age, 76±6.6 years; ages, ≥65 years; 77.9% men) were examined. Of these patients, 13,075 received EVR and 3311 received surgical repair. All repair procedures took place between 2003 and 2015. The primary study outcomes were type of repair procedure and long-term all-cause mortality rates. Endovascular repair was used as the reference treatment.
The rate of surgical repair of AAA was found to be higher for women than men (27% vs 18%, respectively; P <.001). After adjusting for risk factors, women were found to be more likely to receive open surgical repair than men (risk ratio, 1.65; 95% CI, 1.51-1.80). . Women also had lower long-term survival rates after EVR (23% vs 37%, respectively; P <.001), as well as a lower risk-adjusted 10-year survival rate (28% vs 35%, respectively; P =.006), compared with men. Survival rates after surgical repair were comparable in women and men (32% vs 36%, respectively; P =.22). After adjusting for risk factors, mortality rates after EVR were still higher in women vs men (HR, 1.13; 95% CI, 1.03-1.24), and the risk for death after open surgical repair remained comparable between sexes (HR, 0.94; 95% CI, 0.84-1.06). Stratification by both symptom severity indicated that the greater mortality risk in women vs men was only observed in patients with ruptured AAA undergoing elective EVR or open surgical repair (HR, 1.13; 95% CI, 1.03-1.24).
Study limitations include missing data for some participants, reduced generalizability due to cohort homogeneity (93% white), and an inability to establish causality between sex and mortality.
“The differential treatment benefit of EVR repair in women is concerning given the shift toward an EVR-first approach to AAA management. In the era of personalized medicine, understanding sex-based differences in AAA treatment and mortality using real-world data with considerable representation of women appears to be crucial to developing AAA management strategies that offer the greatest benefit of AAA repair to both men and women,” noted the study authors.
Ramkumar N, Suckow BD, Arya S, et al. Association of sex with repair type and long-term mortality in adults with abdominal aortic aneurysm [published online February 5, 2020]. JAMA Netw Open. doi: 10.1001/jamanetworkopen.2019.21240