• Sara Allievi, Vinamr Rastogi, Sai Divya Yadavalli, Tim J Mandigers, Jorge L Gomez-Mayorga, Sarah E Deery, Ruby C Lo, VerhagenHence J MHJMDepartment of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands., Santi Trimarchi, and Marc L Schermerhorn.
• Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
• Ann. Surg. 2024 Jul 1; 280 (1): 165172165-172.

ObjectiveThe aim of this study was to evaluate the association between sex and outcomes following thoracic endovascular aortic repair (TEVAR) for intact isolated descending thoracic aortic aneurysms (iiDTAA).BackgroundData regarding sex-related long-term outcomes after TEVAR for iiDTAA are limited and conflicting results regarding perioperative outcomes have been reported.MethodsWe included all TEVAR for iiDTAA between 2014 and 2019 in the Vascular Quality Initiative linked to Medicare claims, allowing reliable assessment of long-term outcome data. Primary outcomes included 5-year mortality, reinterventions, and ruptures of the thoracic aorta. Secondarily, we assessed perioperative outcomes.ResultsWe identified 685 patients, of which 54% were females. Females had higher aortic size index {females vs males: 3.31 [interquartile range (IQR), 2.81-3.85] cm/m 2 vs 2.93 (IQR, 2.42-3.36) cm/m 2 ; P <0.001}, were more frequently symptomatic (31% vs 20%; P =0.001), had longer procedure time [111 (IQR, 72-165) minutes vs 97 (IQR, 70-146) minutes] and more iliac procedures (16% vs 7.6%; P =0.001). Compared with males, females had similar rates of 5-year mortality [58% vs 53%; hazard ratio (HR), 0.93; 95% CI: 0.71-1.22; P =0.61), reinterventions (39% vs 30%; HR, 1.12; 95% CI: 0.73-1.73; P =0.60), and late ruptures (0.6% vs 1.2%; HR, 0.87; 95% CI: 0.12-6.18; P =0.89). After adjustment, these outcomes remained similar through 5 years. Furthermore, perioperative mortality was not significantly different between sexes (4.1% vs 2.2%; P =0.25), as were rates of any complication as a composite outcome (16% vs 21%; P =0.16), as well as of individual complications (all P >0.05).ConclusionOur findings suggest that females who undergo TEVAR for iiDTAA have similar 5-year and perioperative outcomes as compared with males.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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