Mortality Risk for Ruptured Abdominal Aortic Aneurysm in Women.

BACKGROUND: Sex differences in presentation and outcomes of abdominal aortic aneurysms (AAA) with increased mortality rates in women are suggested. This study aimed to assess mortality risk after repair of ruptured AAA (rAAA) in women in the endovascular abdominal aortic repair (EVAR) era. METHODS: Patients treated between 2006 and 2015 for rAAA were included in a prospective database. Characteristics at presentation and outcomes were compared between women and men. Multivariable logistic regression and Cox proportional analyses were performed to identify the effect of sex adjusted for other predictors on mortality. RESULTS: One hundred thirteen patients were identified; of these, 17.7% (20/113) of the patients were women. Forty-four procedures (38.9%) were by EVAR, with comparable rates in women (45%) and men (37.6%, P = 0.62). On admission, women and men shared similar comorbidities and presentation (shock 45% vs. 43.0%, P = 0.81; free rupture 65.0% vs. 67.7%, P = 0.80) and comparable mean aneurysm diameter (76.5 vs. 78.8 mm, P = 0.68), but women were older (mean age 86.4 + 5.5 vs. 75.2 ± 10.6 years, P < 0.0001) and octogenarian women were twice as likely as men (90% vs. 40%, P < 0.0001). Perioperative mortality was comparable between women and men (40.0% vs. 38.7%) either after EVAR (22.2% vs. 40.0% in women and men respectively; odds ratio [OR] 0.45, 95% confidence interval [CI] 0.77-2.37) or after open surgery (54.5% vs. 37.9%; OR 2.0, 95% CI 0.54-7.21), even though there was a trend for lower mortality in women with EVAR. In adjusted analyses, female sex was not associated with perioperative mortality as it was for older age (octogenarians: OR 6.6, 95% CI 2.08-20.82, P = 0.001) and free rupture (OR 4.2, 95% CI 1.29-13.73, P = 0.02). Mean follow-up was 34.32 months. After controlling for age, surgical repair, free rupture, cardiac disease, and shock at presentation, female sex was not a predictor of late mortality. CONCLUSIONS: AAA repair is often delayed in women and applied at older age; nevertheless, currently women do not show increased perioperative mortality risks from rAAA treatment after the introduction of EVAR.

Percutaneous approach in the maintenance and salvage of dysfunctional autologous vascular access for dialysis.

PURPOSE: Endovascular procedures have been increasingly used for salvage of failing vascular access with conflicting results. The aim of this study was to assess the mid-term patency and complication rates of angioplasty procedures performed in a single center for treatment of stenosis compromising vascular accesses. METHODS: A prospective database of vascular accesses performed in 2006-2010 was investigated. The endovascular approach was applied following a standardized protocol by a dedicated team. A total of 531 consecutive procedures were reviewed (326 men; mean age 70.94 years). Patency rates were estimated using the Kaplan-Meier method. RESULTS: There were 199 procedures for failing access: 135 were surgical and 64 angioplasties performed for anastomosis (n=27), venous (n=45) or arterial (n=7) stenosis. Immediate technical success of endovascular procedures was 95.3%(61/64); complication rate was 6.3% (4/64). Primary patency rates were 55% at six months, 49% at 12 months, and 21% at 24 months. In the concurrent group of 135 open procedures, primary patency rates were 80% at six months and 67% at 12 months (P=.002); nevertheless, at 24 months, patency was as low as 49%. Cost estimates for angioplasty revealed additional fees ranging from 411.34 to 446.34 Euro with respect to open surgical procedures. CONCLUSIONS: Most dysfunctional vascular accesses can be successfully and safely treated by the endovascular route. In spite of poor mid-term durability, the angioplasty balloon might be considered as a bridge, effective, and repeatable solution with reasonable costs to prolong access survival avoiding additional surgery. The failure rate in the mid-term for dysfunctional vascular access may also be high after surgical reintervention.