ArticleJournal of vascular surgery2020
Female sex is associated with comparable 5-year outcomes after contemporary endovascular aneurysm repair despite more challenging anatomy.
Article in Journal of vascular surgery, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
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Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it, 58 citations in OpenAlex.
- Sex Differences in Outcomes After Endovascular Abdominal Aortic Aneurysm Repair: A Systematic Review and Narrative Synthesis.Reviews in cardiovascular medicine · 2026Pooled it
- Influence of Foehn on Aortic Aneurysm Ruptures in Southern Germany.Journal of clinical medicine · 2025Article
- Impact of Sex-Related Differences in Infrarenal Aortic Neck Morphology on Outcomes of Endovascular Aneurysm Repair for Similar-Sized Aortic Aneurysm.Diagnostics (Basel, Switzerland) · 2025Article
- Sex differences in hospital outcomes of medically-managed type B aortic dissection.Frontiers in cardiovascular medicine · 2025Article
- Male-Female Differences in Acute Type B Aortic Dissection.Journal of the American Heart Association · 2024Article
- Sex-Related Differences in Proximal Neck Anatomy and Their Consequences in Patients after EVAR: A Matched Cohort Analysis.Journal of clinical medicine · 2023Article
- Gender Influence on Abdominal Aortic Aneurysm Surgery in a Caribbean Population.The International journal of angiology : official publication of the International College of Angiology, Inc · 2023Article
- Sex differences in specialized pro-resolving lipid mediators and their receptors in abdominal aortic aneurysms.JVS-vascular science · 2023Article
- Disparities in reporting and representation by sex, race, and ethnicity in endovascular aortic device trials.Journal of vascular surgery · 2022Article
- Sex-specific criteria for repair should be utilized in patients undergoing aortic aneurysm repair.Journal of vascular surgery · 2022Article
- Epidemiology of endovascular and open repair for abdominal aortic aneurysms in the United States from 2004 to 2015 and implications for screening.Journal of vascular surgery · 2021Article
- Outcomes after EVAR in females are similar to males.BMC cardiovascular disorders · 2021Article
- Article
- Gender-Based Differences in Abdominal Aortic Aneurysm Rupture: A Retrospective Study.Journal of clinical medicine research · 2020Article
- Gender differences of morphological and hemodynamic characteristics of abdominal aortic aneurysm.Biology of sex differences · 2020Article
Corrections and comments
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Authors and funding
9 authors at 9 institutions in 7 countries.
Funding
Abstract
backgroundWomen with abdominal aortic aneurysms less often meet anatomic criteria for endovascular repair and experience worse perioperative and long-term survival.
methodsWe compared long-term survival, aneurysm-related mortality, and rates of endoleaks and reinterventions between male and female patients in the Endurant Stent Graft Natural Selection Global Postmarket Registry (ENGAGE) using 2:1 propensity score matching.
resultsThere were 1130 male patients and 133 female patients, yielding 399 patients after matching (266 male patients, 133 female patients). Female patients were older, with smaller aneurysms, smaller iliac arteries, and shorter, more angulated necks, and they were more often treated outside the device instructions for use (all P < .001). Through 5 years, female patients experienced overall mortality comparable to that of well-matched male patients (34% vs 38%, respectively; hazard ratio, 0.89 [0.61-1.29]; P = .54) and lower aneurysm-related mortality (0% vs 3%; P = .047). Female patients experienced higher rates of any postoperative type IA endoleak through 5 years (10% vs 1%; P < .001) but comparable rates of secondary endovascular procedures (14% vs 16%; P = .40). Female sex was independently associated with significantly higher risk of long-term type IA endoleaks (hazard ratio, 4.8 [1.2-20.8]; P = .04), even after accounting for anatomic factors. No female patient experienced aneurysm rupture during follow-up, and only one female patient underwent conversion to open repair.
conclusionsDespite more challenging anatomy, female patients in the ENGAGE registry had long-term outcomes comparable to those of male patients. However, female patients experienced higher rates of type IA endoleaks. Although standard endovascular aneurysm repair remains a viable solution for most women, whether high-risk patients may be better served with open surgery, custom-made devices, EndoAnchors (Aptus Endosystems, Sunnyvale, Calif), or chimneys is worthy of further study.
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