This study by Ulug et al. (Lancet, 2017) aimed to determine if there are differences in surgical approaches and outcomes between women and men with intact abdominal aortic aneurysm. Endovascular repair (EVAR) is done by delivering graft components through the common femoral artery. When the endograft expands, it contacts the aortic wall proximal and distal to the aortic aneurysm, and the blood can now flow without causing pressure on the aneurysm. The more traditional approach is an open repair that entailed aortic clamping and considerably higher 30-day mortality rates.
Systematic Review and Meta-Analysis
Five studies with a total of 400 women and 1,507 men were included. Women had significantly higher 30-day mortality rates irrespective of type of repair with an EVAR odds ratio of 1.67 (95% CI 1.38–2.04) and for open repair the odds ratio was 1.76 (1.35–2.30). The proportion of women eligible for EVAR was lower than the proportion of men (34% vs. 54%, respectively; odds ratio 0·44, 95% CI 0.32-0.62). Non-intervention rates were higher in women than in men (34% vs. 19%, respectively; odds ratio 2.27, 95% CI 1.21-4.23). Women had open repair more often than men (5.4% vs. 2.8%, respectively; odds ratio 1.76, 95% CI 1.35-2.30). The authors conclude mortality for women following abdominal aneurysm is indeed worse. Furthermore, women are more likely to not receive treatment. If treated, it is more likely to be repaired with the more dangerous open method rather than the safer EVAR, possibly because women’s aortas are more narrow and current EVAR grafts may not suitable. Recommendations for improvement include a lower threshold for diagnosis so that women may be treated at an earlier age which confers better prognosis and reduce risks of surgery. In addition, endografts should be designed for women, and referrals to high risk centers should be considered where there is more experience with aneurysm surgery.
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