This article is more than 5 years old. Information may no longer be current.
Women less likely eligible for EVAR, face poorer outcomes than men
Click Here to Manage Email Alerts
Compared with men, fewer women are eligible for and are offered endovascular aneurysm repair, and women have higher operative mortality during endovascular aneurysm repair and open repair, according to a systematic review and meta-analysis published in The Lancet.
Researchers conducted three reviews of intact aneurysm repair studies and stratified results by sex: One for whether patients were morphologically suitable for EVAR, one for nonintervention rates and one for 30-day mortality. They combined results across studies using a random-effects meta-analysis.
For the morphological suitability review, Pinar Ulug, PhD, from the Vascular Surgery Research Group at Imperial College London, and colleagues evaluated five studies that included 1,507 men and 400 women. The proportion of women eligible for EVAR was 34% vs. 54% for men (OR = 0.44; 95% CI, 0.32-0.62), according to the researchers.
For the nonintervention review, Ulug and colleagues analyzed 1,365 men and 247 women from four single-center studies. Pooled nonintervention rates were 34% in women vs. 19% in men (OR = 2.27; 95% CI, 1.21-4.23).
For the 30-day mortality review, nine studies were included covering 52,018 men and 11,076 women. Among patients who underwent EVAR, the pooled estimate of 30-day mortality was 2.3% in women and 1.4% in men (OR = 1.67; 95% CI, 1.38-2.04), and a similar trend was found among those who underwent open repair (women, 5.4%; men, 2.8%; OR = 1.76; 95% CI, 1.35-2.3).
“The results of these reviews indicate that the prognosis of women with abdominal aortic aneurysm is worse than that of men; although, we have not considered the management of [CV] risk (often worse in women), complications after repair and longer-term quality or length of life,” Ulug and colleagues wrote. “Women have smaller aortas than men, and perhaps if a smaller threshold for both diagnosis and intervention were introduced, compared with those recommended for men, women might have a better chance of being offered and surviving intervention at a younger age.”
In a related editorial, Minna Johansson, a PhD student from the department of public health and community medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden, and Russell P. Harris, MD, MPH, from Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, wrote that nonintervention may not necessarily be a bad thing given the risks involved with EVAR and open repair, and “a change in the definition of the diagnosis for women might result in increased harm due to overdiagnosis and overtreatment of [AAAs] that would never have caused symptoms.”
They wrote, “We cannot simply generalize thresholds developed in men to women, and we need as strong evidence for [AAA] in women, as we have for men.” – by Erik Swain
Disclosure: The researchers, Harris and Johansson report no relevant financial disclosures.
Click Here to Manage Email Alerts