Sex Stratified Outcome Differences Between Fenestrated Endovascular Aneurysm Repair and Open Repair for Juxtarenal Abdominal Aortic Aneurysms.

Introduction: This study aims to investigate if benefits in patient outcomes conferred by endovascular repair compared to open repair of complex abdominal aortic aneurysms (cAAA) are maintained across genders. We undertook a comparative analysis of perioperative outcomes between open repair and fenestrated endovascular repair (FEVAR) utilizing the Cook Zenith Fenestrated (ZFEN) graft for complex abdominal aortic aneurysms (cAAA).

Methods: A retrospective cohort study was conducted using data from the National Surgical Quality Improvement Program (NSQIP) registry, including patients who underwent open repair or ZFEN for cAAA between 2011 and 2022. The study population stratified by sex contained 1,697 males and 663 females. Perioperative outcomes such as mortality, complications, and reoperation rates were analyzed using inverse probability weighting and logistic regression to adjust for confounding indications for surgery.

Results: Among males, those undergoing ZFEN had significantly lower odds of major complications (14% vs. 28%, aOR 0.43, p<.001), reoperation (6.0% vs. 12%, aOR 0.46, p=.03), and major respiratory complications (5.5% vs. 12%, aOR 0.42, p=.02) compared to open repair. In females, the trend towards reduced major complications with ZFEN (19% vs. 31%, aOR 0.50, p=.06) did not reach statistical significance. When comparing males to females undergoing open repair, males had 6.7 times higher odds of myocardial infarction, and 16 times higher odds of wound complications compared to females. Conversely, females undergoing ZFEN had higher odds of reoperation compared to males (12% vs. 4.1%, aOR 0.13, p=.012).

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