(IP061) Sex Stratified Outcome Differences Between Cook Zenith Fenestrated and Open Approach for Complex AAA

Objectives: Despite having lower co-morbidities, women have worse clinical outcomes after aortic aneurysm repair compared to men overall. Endovascular repair confers an advantage over open aortic repair in the immediate post operative setting for both sexes. Given the increasing complexity of abdominal aortic aneurysm repair, we aimed to investigate if benefits in patient outcomes conferred by endovascular repair versus open are maintained across the sexes.

Methods: A retrospective cohort study was conducted using data from the National Surgical Quality Improvement Program (NSQIP) registry, that included patients who underwent open repair or fenestrated endovascular repair (FEVAR) for complex aortic aneurysm repair, defined as abdominal aortic aneurysms involving branch vessels, between 2011 and 2022. The cohort was stratified by sex: 1,697 men and 663 women. Perioperative outcomes evaluated included perioperative mortality, reoperation, cardiac complications, major respiratory complications, major renal complication, stroke, ischemic colitis, lower extremity ischemia, sepsis, and wound complications. Analysis was performed using inverse probability weighting and logistic regression to adjust for confounding indications for surgery.

Results: Among men, those undergoing FEVAR had significantly lower odds of major complications (14% vs. 28%, aOR 0.43, p< 0.001), reoperation (6.0% vs. 12%, aOR 0.46, p< 0.05), and major respiratory complications (5.5% vs. 12%, OR 0.42, p< 0.05) compared to open repair (Table I). In women, the trend towards reduced major complications with FEVAR (19% vs. 31%, aOR 0.50, p=NS) did not reach statistical significance. When comparing men to women undergoing open repair, men had 6.7x higher odds of myocardial infarction, and 16x higher odds of wound complications compared to women. Women undergoing FEVAR had higher odds of reoperation compared to men (4.1% vs. 12%, aOR 0.13, p=.012) (Fig 1).

Conclusions: The study highlights significant sex-specific differences in outcomes following both FEVAR and open repair for cAAA. FEVAR offers notable advantages in reducing complications for men, while its benefits are less pronounced in women. These findings underscore the need for tailored treatment strategies and further research to optimize outcomes for women undergoing aortic aneurysm repair.