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Death rate higher for women after endovascular aneurysm repair
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ChiCAGO (August 25, 2009) — A new study of 30-day outcomes in patients who had endovascular aneurysm repair (EVAR) for aortic abdominal aneurysms (AAAs), revealed that overall morbidity and mortality for all patients were 11.9 percent and 2.1 percent, respectively. However when comparing men and women, mortality was almost twice as high in women than men (3.4 percent vs. 1.8 percent) and a broad range of postoperative complications also were more likely to occur in females (17.8 percent vs. 10.6 percent). Complete details about this study may be found in the in the Society for Vascular Surgery’s® September 2009 issue of the Journal of Vascular Surgery®.


Aneurysms affect men four to five times more often than women. A AAA is a weakness of the wall of the aorta (the main vessel that lies in the back of the abdomen and supplies blood to the intestines, liver, kidneys, and legs). Studies have shown that EVAR, in which a stent graft is released on the inside of the aorta under x-ray guidance rather than more invasive open surgery to prevent a rupture, is possible in up to 70 percent of patients.

Dr. Endean and his colleagues from the department of surgery at the University of Kentucky College of Medicine in Lexington used the American College of Surgeons National Surgical Quality Improvement Program Dataset participant file to identify 3,662 patients who had EVAR at 173 hospitals during the years 2005-2007. There were 647 women (17.7 percent) and 3,015 men (82.3 percent) in the study. Data also was analyzed for 55 preoperative defined risk factors, eight procedural and intraoperative variables and outcomes including 21 postoperative complications. 

“Women were more likely to present more emergently, have more complex and longer operations, require postoperative blood transfusion, have longer length of stays,” said Dr. Eric D. Endean MD, FACS, professor of surgery and section head of vascular surgery, as well as program director for the General Surgery Residency Program, at the University of Kentucky College of Medicine in Lexington.


He added that women often have a debilitated physical condition prior to surgery (recent weight loss, morbid obesity, and functional dependence), chronic obstructive pulmonary disease, or require more complex and longer operations. Females also were found to have an independent risk factor for infectious complications, wound complications.

“While the reasons for the risk with EVAR cannot be definitively identified from data obtained in the current study, we hypothesize that at least one factor contributing to this finding may be more challenging aortic anatomy in women,” added Dr. Endean. “Women tend to have smaller vessels, may present for treatment later than men, and may have other anatomic characteristics of the aorta that make EVAR more difficult. In order to improve outcomes of women who undergo repair of their aneurysm using EVAR we recommend that surgeons appropriately select patients for EVAR and pay close attention to their other medical conditions.”

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