Abstract 12752: Mortality Risk for Ruptured Abdominal Aortic Aneurysm After Endovascular and Open Intervention in Women

Hypothesis: There may be sex differences in presentation and outcomes of abdominal aortic aneurysms (AAA) with increased mortality rates in women. Aim of this study was to assess mortality risk after repair of ruptured AAA (rAAA) in women in the endovascular repair (EVAR) era. Methods: All patients treated in 2006-2014 for rAAA were reviewed. Characteristics at presentation and outcomes were compared between women and men. Multivariable logistic regression and Cox proportional hazards modeling were performed to identify the effect of sex adjusted for other predictors on mortality. Results: One-hundred and four patients were identified: 16.3% (17/104) were women. Forty-one procedures (39.4%) were by EVAR, with comparable rates in women (47.1%) and men (37.9%;P=0.59). On admission women and men shared similar comorbidities and presentation (shock rates 43.8% vs. 45.9%; P=1; free rupture rates 58.8% vs. 67.8%; P=0.58 ) and comparable mean aneurysm diameter (76.2mm vs.77.7mm;P=0.8) but women were older (mean age 86.2+5.8 vs. 75.5 +10.3 years; P<0.0001) and octogenarian women were twice as likely as men (88% vs. 40% P<0.0001). Sex-related age difference was more evident within the open surgery group. Perioperative mortality was not different between women and men (35.3% vs. 35.6%) either after EVAR [25.0% vs. 33% in women and men respectively;Odds Ratio(OR) 0.7; 95%Confidence Interval (CI) 0.12-3.9] or after open surgery (44.4% vs. 37.0%; OR 4.7;95%CI 0.98-24.8), even though there was a trend for lower mortality in women with EVAR. In adjusted analyses, female sex was not associated with perioperative mortality as it was for old age (OR 5.5;95%CI 1.7-18.3) and free rupture (OR 3.5;95%CI 1.06- 11.7). At a mean follow-up of 22.3 months late survival was worse in women than in men but only for patients undergoing open surgery and the difference did not attain statistical relevance. After controlling for age, surgical repair, free rupture, cardiac disease, female sex was not predictor of late mortality. Conclusions: Despite AAA repair is often delayed in women and applied at older age, women might not show increased perioperative mortality risks from rAAA treatment after the introduction of EVAR. Larger data are required to confirm this hypothesis.