# Influence of sex and advanced age on outcomes after endovascular aneurysm repair: a 13-year single-center retrospective cohort study

## TL;DR

This study finds that older patients and women face higher risks and challenges after aortic aneurysm repair, suggesting the need for tailored treatment approaches.

## Contribution

The study provides new insights into how age and sex affect outcomes in endovascular aneurysm repair through a long-term single-center cohort analysis.

## Key findings

- Octogenarians had a 2.43-fold increased mortality risk compared to younger patients.
- Women had significantly higher Type I endoleak rates and more complex vascular anatomy.
- Age ≥80 years was a strong predictor of mortality, while sex was not independently predictive.

## Abstract

Sex and advanced age may influence anatomical complexity and clinical outcomes after endovascular abdominal aortic aneurysm repair (EVAR). This study evaluated the impact of sex and age ≥ 80 years on peri-operative and long-term outcomes following EVAR.

We conducted a 13-year, single-center retrospective cohort study of 512 patients (311 men, 201 women) who underwent EVAR for infrarenal abdominal aortic aneurysm between 2010 and 2023. Patients were stratified by sex and by age (<80 vs. ≥80 years). The primary endpoint was long-term all-cause mortality. Secondary endpoints included perioperative outcomes, Type I endoleak incidence, and reintervention rates. Mortality predictors were assessed using Cox proportional hazards regression. Median follow-up time was 95 months.

Women and octogenarians had significantly larger aneurysm diameters and greater aortic neck angulation (both p < 0.001). Type I endoleak incidence was significantly higher in women (26.4% vs. 11.9%, p < 0.001) and in patients ≥80 years (32.2% vs. 11.4%, p < 0.001). Cox regression demonstrated that age ≥80 years increased mortality risk 2.43-fold [hazard ratio (HR) = 2.430; 95% confidence interval: 1.430–4.127; p = 0.001], whereas sex was not an independent predictor of mortality (p = 0.185).

Octogenarians exhibited markedly higher mortality risk, and women presented with more challenging vascular anatomy and a higher rate of Type I endoleaks. These findings are consistent with reported anatomical and outcome disparities in high-risk AAA populations.

These results emphasize that tailored pre-operative planning, device selection, and long-term follow-up strategies may optimise outcomes in elderly and female patients and align with contemporary vascular surgery guidelines.