Sex-related Outcomes After Thoracic Endovascular Repair for Intact Isolated Descending Thoracic Aortic Aneurysm: A Retrospective Cohort Study

Objective: The aim of this study was to evaluate the association between sex and outcomes following thoracic endovascular aortic repair (TEVAR) for intact isolated descending thoracic aortic aneurysms (iiDTAA). Background: Data regarding sex-related long-term outcomes after TEVAR for iiDTAA are limited and conflicting results regarding perioperative outcomes have been reported. Methods: We included all TEVAR for iiDTAA between 2014 and 2019 in the Vascular Quality Initiative linked to Medicare claims, allowing reliable assessment of long-term outcome data. Primary outcomes included 5-year mortality, reinterventions, and ruptures of the thoracic aorta. Secondarily, we assessed perioperative outcomes. Results: We identified 685 patients, of which 54% were females. Females had higher aortic size index {females vs males: 3.31 [interquartile range (IQR), 2.81-3.85] cm/m² vs 2.93 (IQR, 2.42-3.36) cm/m²; P<0.001}, were more frequently symptomatic (31% vs 20%; P=0.001), had longer procedure time [111 (IQR, 72-165) minutes vs 97 (IQR, 70-146) minutes] and more iliac procedures (16% vs 7.6%; P=0.001). Compared with males, females had similar rates of 5-year mortality [58% vs 53%; hazard ratio (HR), 0.93; 95% CI: 0.71-1.22; P=0.61), reinterventions (39% vs 30%; HR, 1.12; 95% CI: 0.73-1.73; P=0.60), and late ruptures (0.6% vs 1.2%; HR, 0.87; 95% CI: 0.12-6.18; P=0.89). After adjustment, these outcomes remained similar through 5 years. Furthermore, perioperative mortality was not significantly different between sexes (4.1% vs 2.2%; P=0.25), as were rates of any complication as a composite outcome (16% vs 21%; P=0.16), as well as of individual complications (all P>0.05). Conclusion: Our findings suggest that females who undergo TEVAR for iiDTAA have similar 5-year and perioperative outcomes as compared with males.