Geschlechtsspezifische Langzeitergebnisse nach elektiver endovaskulärer Versorgung abdomineller Aortenaneurysmen bei Verwendung von Stentgrafts mit und ohne Fenestrierung oder Seitenarm

This study aimed to assess long-term gender-specific outcomes after elective endovascular repair of intact abdominal aortic aneurysms (AAAs) depending on the choice of stent graft.

A retrospective analysis of anonymized data of a German health insurance company (AOK) was performed. A total of 15,699 patients (86.6% men) with endovascular AAA repair between January 1, 2010, and December 31, 2016, were included. The follow-up period ended on December 31, 2018. In 12,922 patients (82.3%) an aortobiiliac graft without fenestration or side branch (F/B) was used, in 881 patients (5.6%) an aortobiiliac graft with F/B, in 1010 patients (6.4%) an aortouniiliac graft, and in 886 patients (5.6%) a tube graft was used.

Perioperative mortality was significantly lower in men (2.2%) compared to women (3.6%; p < 0.001) among patients with an aortobiiliac bifurcation graft without F/B. However, there were no significant differences in perioperative mortality between men and women in the other groups. Patients with an aortouniiliac graft had a significantly higher in-hospital mortality (5.5%) than patients with an aortobiiliac bifurcation graft without F/B (2.4%; p < 0.001) and higher mortality than patients with a tube graft (3.3%, p = 0.019). The long-term survival of men was significantly better than that of women (46.9% vs. 43.6%; p = 0.002). Patients with an aortobiiliac bifurcation graft without F/B had significantly better survival after 9 years (47.7%) than those with an aortobiiliac bifurcation with F/B (45.6%; p < 0.001), with an aortouniiliac graft (36.4%, p < 0.001), or with a tube graft (42.1%, p < 0.001).

Women had significantly less favorable perioperative outcomes compared to men. However, risk-adapted gender was not a risk factor for long-term survival. In the long-term, patients with an aortobiiliac graft without F/B had better outcomes compared to patients with an F/B graft. The least favorable results were obtained with aortouniiliac grafts.