Noticias

Noticias

  • Título: We Knew It: Female Gender Is a Risk Factor for TEVAR
  • Fecha: 13-11-2014

  • George J. Arnaoutakis et al. (from Johns Hopkins in Baltimore, MD) just published an important study in the January 2014 issue of the Journal of Vascular Surgery (J Vasc Surg 2014;59:45–51). As summarized in the article, the investigators conducted a review of the 2005 to 2011 ACS-NSQIP database to identify all patients who underwent TEVAR for nonruptured thoracic aortic aneurysms. Procedure and diagnosis codes were used to capture the study population. Patients were stratified according to gender. Baseline, operative, and outcomes data were compared in a bivariate fashion. The primary outcome measure was 30-day mortality, and a risk-adjusted generalized linear model with Poisson distribution was used to identify relative risk.

    During the study period, 649 patients (279 women [43%] and 370 men [57%] underwent TEVAR. Baseline demographics according to patient sex were similar; however, women were less likely to drink alcohol (1% vs 5%; P=.001) and to have a history of cardiac surgery (14% vs 27%; P<.001). Further, more women required iliac artery exposure (18% vs 7%; P<.001). Operative times (173.6 ± 6.3 minutes vs 159.8 ± 5.2 minutes; P=.03), transfusion rates (30% vs 17%, P=.001), and hospital length of stay (7.7 ± 0.5 days vs 7.6 ± 0.5 days; P=.009) were increased in women compared with men.

    Overall, postoperative complications were similar, but unadjusted mortality was significantly greater in women (6% vs 3%; P=.03). On multivariable analysis, female sex was no longer a significant predictor of mortality (relative risk [RR], 2.3; 95% confidence interval [CI], 0.99–5.34; P=.053). Independent predictors of 30-day mortality included older age (RR, 1.05; 95% CI, 1.01–1.09; P=.02), emergent procedure setting (RR, 3.76; 95% CI, 1.79–7.87; P<.001), and iliac artery exposure (RR, 4.42; 95% CI, 2.07–9.44; P<.001). The investigators concluded that 30-day unadjusted mortality after TEVAR for nonruptured thoracic aortic aneurysms was higher in women compared with men, but this univariate finding did not persist after risk adjustment. Multivariable analysis showed that a need for iliac artery exposure, older age, and emergency surgery were independently associated with higher mortality rates. These results suggest a need for decreased device delivery sizes and improvements in endovascular thoracic devices.

    In light of these findings, stent-graft manufacturers and endovascular researchers and engineers should refocus on profile as a priority goal for near-future technological improvements. Availability of thoracic delivery systems under 20 Fr outer diameter would go a long way to remedy the disadvantaged situation many women find themselves in today when afflicted with aortic pathologies.



  • Fuente: endovascular.es