Association between sex and perioperative mortality following endovascular repair for ruptured abdominal aortic aneurysms

Background: Women are recognized to experience inferior outcomes following open surgery for elective or ruptured abdominal aortic aneurysm (rAAA) when compared with men. The objective of this review was to assess whether there is a sex difference on mortality in patients receiving endovascular aneurysm repair (EVAR) for rAAA. Methods: A systematic literature review from 2005 to 2012 was performed to investigate early mortality risk of ruptured endovascular aneurysm repair (rEVAR) stratified by sex. Data were analyzed with random-effect meta-analysis; pooled odds ratios (ORs) were calculated for women compared with men. Results: Thirteen studies provided the required information; in most (n [ 9), data stratified by sex was identified through unpublished data from direct contact with authors. No study was randomized; there were four prospective and 10 retrospective series. Three were United States population studies. The number of women was limited in most articles. Data were available for 5580 patients treated with rEVAR; 1339 were women (23.9%). Perioperative mortality with rEVAR occurred in 473/1339 women (pooled rate 35.6%; 95% confidence interval [CI], 33.1-38.2) and in 1334/4241 men (pooled rate 31.7%; 95% CI, 30.3-33.1) without significant difference between sex categories (pooled odds ratio 1.22; 95% CI, 0.97-1.54; P [ .09). There was no increased mortality risk in women vs men in ancillary analyses stratified by study size and after excluding unpublished data. Conclusions: Women may benefit as much as men from EVAR for rAAA. Nevertheless, current evidence supporting EVAR for female patients with rAAA is weak and requires confirmation by further experiences with a larger female representation.