Gender-Specific Long-Term Results After Elective Open Abdominal Aortic Aneurysm Repair Depending on the Site of Distal Anastomosis.

Vascular and endovascular surgery Pub Date : 2025-01-01 Epub Date: 2024-08-28 DOI:10.1177/15385744241276702
Sonny Gennaro Annunziata, Jasmin Epple, Thomas Schmitz-Rixen, Dittmar Böckler, Reinhart T Grundmann
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Abstract

Objective: Analysis of gender-specific differences in short- and long-term outcome after elective open abdominal aortic aneurysm repair (OAR) regarding the distal anastomosis.

Methods: In this retrospective cohort study, data from 4853 patients of a German health insurance company undergoing OAR for infrarenal abdominal aortic aneurysms (AAAs) between 2010 and 2016 were analysed. The patients were followed through 2018.

Results: A total of 4050 (83.5%) men and 803 (16.6%) women underwent OAR. Women were older than men (72.9 ± 8.7 vs 69.8 ± 8.5 years; P < .001). A tube graft was used in 2644 (54.5%) patients, an aorto-biiliac bifurcated graft in 1657 (34.1%) and an aorto-bifemoral bifurcated graft in 552 (11.4%). Perioperative mortality was not significantly different between men (5.7%) and women (6.5%) in the total patient population (P = .411). This was true for aorto-aortic tube grafting (P = .361), aorto-biiliac reconstructions (P = 1.000) and aorto-bifemoral reconstructions (P = .345). Kaplan-Meier estimated long-term survival of men after 9 years was better than that of women (55.0% vs 43.8%; P = .006). However, separated by the site of the distal anastomosis, this was only true for aorto-aortic reconstructions (survival men vs women 56.0% vs 42.1%; P = .005), not for aorto-biiliac and aorto-bifemoral reconstructions. In the multivariate Cox regression analysis, age over 80 years, heart failure, aorto-bifemoral reconstruction, chronic kidney disease stage 3-5, chronic obstructive pulmonary disease, peripheral artery disease, arterial hypertension, but not gender (P = .531), had a negative impact on long-term survival.

Conclusion: If possible, an aorto-aortic tube graft should be preferred to aorto-biiliac and aorto-bifemoral reconstructions in OAR. Patients selected for aorto-bifemoral artery reconstruction exhibit higher perioperative morbidity and mortality as well as worse long-term survival compared to patients selected for an intra-abdominal reconstruction. In the multivariate regression analysis, gender was not an independent risk factor for either short- or long-term outcomes.

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择期开放式腹主动脉瘤修补术后的长期结果因远端吻合部位不同而有性别差异。
目的分析择期开放式腹主动脉瘤修补术(OAR)远端吻合术后短期和长期预后的性别差异:在这项回顾性队列研究中,分析了一家德国医疗保险公司在 2010 年至 2016 年间为肾下腹主动脉瘤(AAA)接受开放性腹主动脉瘤修补术的 4853 名患者的数据。结果:共有 4050 名男性(83.5%)和 803 名女性(16.6%)接受了 OAR。女性年龄高于男性(72.9 ± 8.7 岁 vs 69.8 ± 8.5 岁;P < .001)。2644例(54.5%)患者使用了管道移植,1657例(34.1%)使用了主动脉-髂骨分叉移植,552例(11.4%)使用了主动脉-股骨分叉移植。在所有患者中,男性(5.7%)和女性(6.5%)的围手术期死亡率没有明显差异(P = .411)。主动脉管移植术(P = .361)、主动脉-髂重建术(P = 1.000)和主动脉-双股动脉重建术(P = .345)的情况也是如此。据 Kaplan-Meier 估计,男性 9 年后的长期存活率高于女性(55.0% vs 43.8%;P = .006)。但是,根据远端吻合部位的不同,只有主动脉重建(男性存活率 56.0% vs 女性存活率 42.1%;P = .005)才会出现这种情况,而主动脉-髂和主动脉-双股动脉重建则不会出现这种情况。在多变量考克斯回归分析中,年龄超过80岁、心力衰竭、主动脉-双股骨重建、慢性肾脏病3-5期、慢性阻塞性肺病、外周动脉疾病、动脉高血压对长期存活率有负面影响,但性别没有影响(P = .531):结论:在可能的情况下,OAR患者应首选主动脉-主动脉管移植,而不是主动脉-髂和主动脉-双股动脉重建。与选择腹腔内重建的患者相比,选择主动脉-双股动脉重建的患者围手术期的发病率和死亡率更高,长期生存率也更低。在多变量回归分析中,性别不是短期或长期结果的独立风险因素。
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