Sex-Related Differences in Proximal Neck Anatomy and Their Consequences in Patients after EVAR: A Matched Cohort Analysis

Introduction: Studies comparing male and female patients with abdominal aortic aneurysms have shown that female patients are generally older and more often experience postoperative complications after endovascular and open repair. There are also indications that female patients have more extensive neck pathologies and that they more often have postoperative complications related to proximal neck pathology. Material and methods: This retrospective study describes all consecutive female patients who underwent EVAR between 1 January 2012 and 31 December 2021. Propensity-score matching was used to obtain a matched control male cohort. Propensity scores were generated with the following anatomic parameters: infrarenal and suprarenal angulation, proximal and distal neck diameter and neck length. 1 Female patient was matched with 3 male patients. Results: A total of 160 patients were included, namely 120 male patients and 40 female patients. Due to matching, there were no significant differences regarding infrarenal and suprarenal angulation and proximal and distal neck diameter and length. All-cause and aneurysm-related mortality were comparable (p = 0.19 and p = 0.98). The necessity of neck-related secondary procedures was significantly higher in female patients (p = 0.02). In the multivariate analysis, the female sex was a significant predictor of endoleak type IA within 30 days. However, there was no significant association between intraoperative endoleak type IA and endoleak type IA at the end of follow-up. Conclusions: This study suggests that there was a higher initial incidence of endoleak type IA in female patients, despite thematched preoperative anatomic parameter. Due to the relatively low number of included female patients, conclusions should be drawn carefully.