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EVAR in women with AAA yields positive clinical outcomes

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HOLLYWOOD, Fla. — Endovascular abdominal aortic aneurysm repair is associated with positive long-term results in women despite being used less frequently than open surgery, according to new data presented at the International Symposium on Endovascular Therapy.

Tina Cohnert, MD, from the division of vascular surgery, Graz Medical University, Graz, Austria, evaluated patient selection, device selection and long-term results of endovascular aneurysm repair (EVAR) in women using prospectively collected data from consecutive patients at a single center who underwent AAA repair.

From October 1996 to June 2015, AAA surgery was performed in 1,487 patients; of those, 223 were women. Overall, open repair was performed in 1,164 patients (194 women). Two hundred forty two patients underwent repair as a result of AAA rupture. Forty-six women required emergency open repair, according to the abstract.

EVAR — only elective, no emergent — was performed in 323 patients (29 women; mean age, 78 years). The devices used were Endurant (Medtronic), Excluder (Gore), Talent (Medtronic), Treovance (Bolton), Vanguard (Boston Scientific) and Zenith (Cook Medical), according to the abstract.

No women died in the hospital after EVAR. Six patients died after the procedure (median, 9 years). One death was due to AAA-related colonic necrosis, two due to stroke and three due to malignancies. Four women underwent conversion: one early conversion on postoperative day 1 and three late conversions at 47, 50 and 54 months. There were no conversions since 2002. No graft limb occlusions or secondary interventions occurred in this group, according to results presented. In other results, complete aneurysm shrinkage occurred in four patients, partial shrinkage in seven patients and no change in eight patients.

“The percentage of women undergoing EVAR is extremely low compared to women undergoing open repair. In this study, this [was] partially due to the exclusive use of EVAR in non-ruptured patients, when 20.6% of all women with AAA presented with rupture. The low operative mortality and very good long-term results should justify a wider use of EVAR in women. AAA screening programs for women, changes in indication for treatment and EVAR device modification to fit female vessel sizes and AAA morphology need further investigation,” Cohnert said. – by Katie Kalvaitis

Reference:

Cohnert T, et al. Concurrent Session I: Peer-Reviewed Abstracts. Presented at: International Symposium on Endovascular Therapy; Feb. 6-10, 2016; Hollywood, Fla.

Disclosure: The researchers report no relevant financial disclosures.