Sex-Based Differences of Thoracic Endovascular Aortic Repair for Stanford Type B Aortic Dissections

Munir Paul Moacdieh; Sina Zarrintan; Claire B Janssen; Kevin S Yei; Rohini J Patel; Ann C Gaffey; Mahmoud B Malas

doi:10.1016/j.avsg.2024.12.043

Sex-Based Differences of Thoracic Endovascular Aortic Repair for Stanford Type B Aortic Dissections

Ann Vasc Surg. 2024 Dec 27:S0890-5096(24)00863-X. doi: 10.1016/j.avsg.2024.12.043. Online ahead of print.

Authors

Munir Paul Moacdieh¹, Sina Zarrintan¹, Claire B Janssen¹, Kevin S Yei¹, Rohini J Patel¹, Ann C Gaffey¹, Mahmoud B Malas²

Affiliations

¹ Department of Surgery, Division of Vascular & Endovascular Surgery, UC San Diego, La Jolla, CA; Center for Learning and Excellence in Vascular and Endovascular Research, UC San Diego, La Jolla, CA.
² Department of Surgery, Division of Vascular & Endovascular Surgery, UC San Diego, La Jolla, CA; Center for Learning and Excellence in Vascular and Endovascular Research, UC San Diego, La Jolla, CA. Electronic address: mmalas@health.ucsd.edu.

PMID: 39733995
DOI: 10.1016/j.avsg.2024.12.043

Abstract

Objective: There is a paucity of data on sex-based differences in outcomes after thoracic endovascular aortic repair (TEVAR) performed for Stanford type B aortic dissections (TBAD). Examining the predictive role of sex could shape future clinical guidelines for TEVAR. Thus, this study aims to evaluate the association between sex and postoperative outcomes after TEVAR performed for TBAD.

Methods: This is a retrospective cohort study utilizing the Vascular Quality Initiative (VQI) from 2011-2024. We included all patients undergoing TEVAR for TBAD with entry tear zones > zone 0. Patients who presented with rupture, had a history of connective tissue disease and underwent conversion to open repair were excluded. Primary outcomes were 30-day mortality, postoperative stroke, myocardial infarction (MI), spinal cord ischemia (SCI), aorta-related reintervention and access-related reintervention. The secondary outcome was freedom from all-cause mortality (ACM) at 1 year.

Results: A total of 5,117 patients underwent TEVAR for TBAD, of which 1,553 (30.3%) were women. Female patients were more likely to have a smaller aortic diameter compared to male patients (42.8 ± 11.5 vs 45.8 ± 14.3; P<0.001). After adjusting for potential confounders, there were no significant differences in 30-day mortality, stroke, MI, SCI and aorta-related reintervention between male and female patients. However, female patients were significantly more likely to undergo postoperative access-related reintervention (aOR=2.4 [95% CI: 1.1-5.0]; P=0.023) compared to male patients. Freedom from ACM at 1 year was similar between males and females (aHR=1 [95% CI: 0.8-1.2]; P=0.955).

Conclusions: In this study using large, real-world data, female patients undergoing TEVAR for TBAD showed an increased risk of postoperative access-related reintervention, possibly due to smaller access vessel diameter. Development of devices that better fit female anatomy may help mitigate these risks in the future.

Keywords: access-related reintervention; gender disparity; thoracic endovascular aortic repair; type B aortic dissection.