Estudo transversal multicêntrico comparando o gênero no reparo endovascular de aneurismas de aorta abdominal infrarrenal. Resultados do Registro dos Hospitais Estaduais Universitários do Interior de São Paulo (RHEUNI)
Cross-sectional, multicenter study comparing sex differences in patients undergoing endovascular repair of infrarenal abdominal aortic aneurysms. Results from the São Paulo State University Provincial Hospitals Registry (RHEUNI)
Regina Moura; Edwaldo Edner Joviliano; Ana Terezinha Guillaumon; Selma Regina de Oliveira Raymundo; Ludwig Hafner; Marcone Lima Sobreira; Marcelo José de Almeida; Daniel Gustavo Miquelin; Martin Geiger; Winston Bonetti Yoshida
Resumo
Palavras-chave
Abstract
Background: Abdominal aortic aneurysms (AAA) are 4-6 times more frequent among men than among women, but prognosis tends to be worse in women. Objective: To compare endovascular procedures to repair infrarenal AAA in men and women, using data from a prospective registry.
Methods: This registry collected data from five university hospitals in the state of São Paulo (Brazil) from 2012 to 2022. A cross-sectional study was conducted compiling demographic data, anatomic variables (aneurysm diameter, short neck, angulated neck, calcified neck, or thrombosed neck; distal neck < 1.5 cm, and tortuous, abnormal iliac arteries), complications (leaks, conversions, and patency or stenosis of branches) and renal failure and mortality at 30 days. The chi-square test and Student’s t test were applied with a 5% significance level. The study was approved by the Ethics Committee (process 4040-2011).
Results: A total of 152 (15.9%) of the patients were women and 799 (84.0%) were men (p < 0.05). The majority were white (80.2% of the women and 87.4% of the men). Diabetes and hypertension were significantly more frequent among the women. The most prevalent shape was fusiform, particularly among the women (95.39% vs. 89.86% among men). Mean diameter was smaller among the women (5.96 cm vs. 6.49 cm; p = 0.0056). The iliac arteries were less often involved among the women (89.40% vs. 73.58%; p = 0.00001). Blood loss was greater in the men (321.40 ml vs. 168.84 ml among the women; p < 0.05). Operative mortality was similar in both sexes, but obstructions were more frequent among the women (15.2% vs. 13.51%; p = 0.017296).
Conclusions: Aneurysmal diameter was smaller and obstructive complications were more frequent among women.
Keywords
Referências
1 Starr JE, Halpern V. Abdominal aortic aneurysms in women. J Vasc Surg. 2013;57(4, Suppl):3S-10S.
2 Brown LC, Powell JT. Risk factors for aneurysm rupture in patients kept under ultrasound surveillance. UK Small Aneurysm Trial Participants. Ann Surg. 1999;230(3):289-96, discussion 296-7.
3 Sweeting MJ, Thompson SG, Brown LC, Powell JT, RESCAN collaborators. Meta-analysis of individual patient data to examine factors affecting growth and rupture of small abdominal aortic aneurysms. Br J Surg. 2012;99(5):655-65.
4 Ulug P, Sweeting MJ, von Allmen RS, et al. Morphological suitability for endovascular repair, non-intervention rates, and operative mortality in women and men assessed for intact abdominal aortic aneurysm repair: systematic reviews with meta-analysis. Lancet. 2017;389(10088):2482-91.
5 Sidloff DA, Saratzis A, Sweeting MJ, et al. Sex differences in mortality after abdominal aortic aneurysm repair in the UK. Br J Surg. 2017;104(12):1656-64.
6 Talvitie M, Stenman M, Roy J, Leander K, Hultgren R. Sex Differences in Rupture Risk and Mortality in Untreated Patients With Intact Abdominal Aortic Aneurysms. J Am Heart Assoc. 2021;10(5):e019592.
7 Budtz-Lilly J, Venermo M, Debus S, et al. Editor’s Choice - Assessment of International Outcomes of Intact Abdominal Aortic Aneurysm Repair over 9 Years. Eur J Vasc Endovasc Surg. 2017;54(1):13-20.
8 Patel J, Pallapothu S, Langston A, et al. A Systematic Review of the Recruitment and Outcome Reporting by Sex and Race/Ethnicity in Stent Device Development Trials for Endovascular Abdominal Aortic Aneurysm Repair. Ann Vasc Surg. 2023;89:353-61.
9 Nana P, Dakis K, Brodis A, et al. A systematic review and meta-analysis on early mortality after abdominal aortic aneurysm repair in females in urgent and elective settings. J Vasc Surg. 2022;75(3):1082-8.e6.
10 Tedjawirja VN, de Wit MCJ, Balm R, Koelemay MJW. Differences in Comorbidities Between Women and Men Treated with Elective Repair for Abdominal Aortic Aneurysms: A Systematic Review and Meta-Analysis. Ann Vasc Surg. 2021;76:330-41.
11 Lo RC, Schermerhorn ML. Abdominal aortic aneurysms in women. J Vasc Surg. 2016;63(3):839-44.
12 Söderberg P, Wanhainen A, Svensjo S. Five year natural history of screening detected sub-aneurysms and abdominal aortic aneurysms in 70 year old women and systematic review of repair rate in women. Eur J Vasc Endovasc Surg. 2017;53(6):802-9.
13 Castro A, Benítez LG, Mejía JC. Registro de Trauma Ocular Colombiano (ReTOC)–Primer reporte. Revista Sociedad Colombiana de Oftalmología. 2019;52:79-86.
14 Gomes LSM, Roos MV, Takata ET, et al. Advantages and limitations of national arthroplasty registries. The need for multicenter registries: the Rempro-SBQ. Rev Bras Ortop. 2017;52(Suppl 1):3-13.
15 Deery SE, Soden PA, Zettervall SL, et al. Sex differences in mortality and morbidity following repair of intact abdominal aortic aneurysms. J Vasc Surg. 2017;65(4):1006-13.
16 Tomee SM, Lijftogt N, Vahl A, Hamming JF, Lindeman JHN. A registry-based rationale for discrete intervention thresholds for open and endovascular elective abdominal aortic aneurysm repair in female patients. J Vasc Surg. 2018;67(3):735-9.
17 Ilyas S, Stone DH, Kang J, et al. Non-guideline-compliant endovascular abdominal aortic aneurysm repair in women is associated with increased mortality and reintervention compared with men. J Vasc Surg. 2022;75(1):118-25.e1.
18 Lee MH, Li PY, Li B, et al. A systematic review and meta-analysis of sex- and gender-based differences in presentation severity and outcomes in adults undergoing major vascular surgery. J Vasc Surg. 2022;76(2):581-94.e25.
19 Pouncey AL, Khan A, Alharahsheh B, Bicknell C, Powell JT. Editor’s Choice - Hypothesis for the Increased Rate of Thromboembolic and Microembolic Complications Following Abdominal Aortic Aneurysm Repair in Women. Eur J Vasc Endovasc Surg. 2022;63(2):348-9.
20 Grootenboer N, van Sambeek MR, Arends LR, Hendriks JM, Hunink MG, Bosch JL. Systematic review and meta-analysis of sex differences in outcome after intervention for abdominal aortic aneurysm. Br J Surg. 2010;97(8):1169-79.
21 Corsi T, Ciaramella MA, Palte NK, Carlson JP, Rahimi SA, Beckerman WE. Female sex is associated with reintervention and mortality following elective endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2022;76(6):1494-501.e1.
22 Shutze WP Sr, Shutze R, Dhot P, Forge M, Salazar A, Ogola GO. Sex as an independent risk factor for long-term survival after endovascular aneurysm repair. J Vasc Surg. 2019;69(4):1080-9.e1.
23 Deery SE, Schermerhorn ML. Should abdominal aortic aneurysms in women be repaired at a lower diameter threshold? Vasc Endovascular Surg. 2018;52(7):543-7.
24 Forbes TL, Lawlor DK, DeRose G, Harris KA. Gender differences in relative dilatation of abdominal aortic aneurysms. Ann Vasc Surg. 2006;20(5):564-8.
25 Malayala SV, Raza A, Vanaparthy R. Gender-based differences in abdominal aortic aneurysm rupture: a retrospective study. J Clin Med Res. 2020;12(12):794-802.
26 Patel PB, De Guerre L, Marcaccio CL, et al. Sex-specific criteria for repair should be utilized in patients undergoing aortic aneurysm repair. J Vasc Surg. 2022;75(2):515-25.
27 Siika A, Lindquist Liljeqvist M, Zommorodi S, et al. A large proportion of patients with small ruptured abdominal aortic aneurysms are women and have chronic obstructive pulmonary disease. PLoS One. 2019;14(5):e0216558.
28 Suckow BD, Scali ST, Goodney PP, et al. Contemporary incidence, outcomes, and survival associated with endovascular aortic aneurysm repair conversion to open repair among Medicare beneficiaries. J Vasc Surg. 2022;76(3):671-9.e2.
Submetido em:
19/05/2024
Aceito em:
27/06/2024
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email