An analysis of early and long-term gender-related outcomes after thoracic endovascular aortic repair

Objectives: To evaluate gender-related outcomes during endovascular treatment of thoracic and thoraco-abdominal aortic diseases (TEVAR). Methods: Multicentre, retrospective, observational cohort study. All TEVARs between January 2005 and April 2023 were identified. Primary outcomes were 30-day mortality, and cumulative survival. Secondary outcomes were vascular access complications, and freedom from TEVAR-related reintervention. Interventions performed in male patients were matched to females on the basis of a one-to-one coarsened exact matching. Results: We identified 151 males who were matched with 151 females. Mortality at 30-day was not statistically different between females and males (11.2% vs 11.2%, P = 1.0). At binary logistic regression analysis, duration of intervention (P = 0.001), and emergency TEVAR (P = 0.001) were associated with mortality at 30 days. Gender did not impact access vessel complication rate [n = 6 (4.0%) vs n = 5 (3.3%), P = 1.0]. The median of follow-up was 46 (IQR, 7-84) months with no difference between males and females [median, 50 (11-95) vs 37.5 (3.5-71.2); P = 0.153]. Estimated survival was not statistically different between females and males (Log-rank χ2 = 0.6, P = 0.442; 95% CI: 110.7-207.3). At Cox's regression analysis, gender did not impact overall survival (HR: 0.8, 95% CI: 0.6-1.3, P = 0.450). Estimated freedom from TEVAR-related reinterventions was not statistically different between females and males (Log-rank χ2 = 0.4, P = 0.837; 95% CI: 187.8-219.3). Conclusions: Female gender itself was not associated with worse 30-day mortality and late survival than males with similar access vessel complication as well as TEVAR-related reintervention rate.