Systematic review and meta-analysis of sex differences in outcomes after endovascular aneurysm repair for infrarenal abdominal aortic aneurysm
Systematic review and meta-analysis of sex differences in outcomes after endovascular aneurysm repair for infrarenal abdominal aortic aneurysm
复制标题
肾下腹主动脉瘤血管内修复术后结局性别差异的系统回顾和荟萃分析
DOI：
10.1016/j.jvs.2019.06.105
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发表时间：
2020-01-01
影响因子：
4.3
通讯作者：
Du, Xiaojiong
中科院分区：
文献类型：
--
作者：
Liu, Yang;Yang, Yi;Du, Xiaojiong
目的：女性在接受血管内动脉瘤修复（EVAR）治疗时面临着独特的挑战，根据既往研究，肾下腹主动脉瘤（AAA）EVAR术后结局的性别差异仍然存在争议。本研究旨在比较肾下 AAA EVAR 后女性和男性的短期和长期结果。 方法：我们对报告肾下 AAA EVAR 后性别差异的所有现有研究进行了全面的系统回顾和荟萃分析，这些研究检索自 MEDICINE、Embase 和 Cochrane 数据库。使用随机效应模型，汇总结果以二分数据的优势比 (OR) 和事件时间数据的风险比的形式呈现。 结果：本荟萃分析纳入了 36 个队列。汇总结果显示，女性的 30 天死亡率（粗略 OR，1.67；95% 置信区间 [CI]，1.50-1.87；P < .001；调整 OR，1.73；95% CI，1.32-2.26；P < .001）、院内死亡率（OR，1.90；95% CI， 1.43-2.53；P < .001）、肢体缺血（OR，2.44；95% CI，1.73-2.43；P < .001）、肾脏并发症（OR，1.73；95% CI，1.12-2.67；P = .028）、心脏并发症（OR，1.68；95% CI，与男性相比，1.01-2.80；P = 0.046）和长期全因死亡率（风险比，1.23；95% CI，1.09-1.38；P = 0.001）；然而，内脏/肠系膜缺血（OR，1.62；95% CI，0.91-2.88；P = .098）、30 天再干预（OR，1.37；95% CI，0.95-1.98；P = .095）、晚期内漏（OR，1.18；95%）没有观察到显着的性别差异。 CI，0.88-1.56；P = .264）和晚期再干预（OR，1.05；95% CI，0.78-1.41；P = .741）。在完整 AAA 亚组中，与男性相比，女性的内脏/肠系膜缺血风险显着增加（OR，1.85；95% CI，1.01-3.39；P = .046），心脏并发症的风险相当（OR，1.64；95% CI，0.85-3.17；P = .138）。结论：与男性相比，女性与肾下 AAA 进行 EVAR 后 30 天死亡率、院内死亡率、肢体缺血、肾脏并发症、心脏并发症和长期全因死亡率风险增加相关。 EVAR 后，女性应接受严格、定期的长期监测。
Objective: Women face distinctive challenges when they receive endovascular aneurysm repair (EVAR) treatment, and according to the previous studies, sex differences in outcomes after EVAR for infrarenal abdominal aortic aneurysm (AAA) remains controversial. This study aimed to compare the short-term and long-term outcomes between women and men after EVAR for infrarenal AAA.Methods: We conducted a comprehensive systematic review and meta-analysis of all available studies reporting sex differences after EVAR for infrarenal AAA, which were retrieved from the MEDICINE, Embase, and Cochrane Database. The pooled results were presented as odds ratios (ORs) for dichotomous data and hazard ratios for time-to-event data using a random effect model.Results: Thirty-six cohorts were included in this meta-analysis. The pooled results showed that women were associated with a significantly increased risk of 30-day mortality (crude OR, 1.67; 95% confidence interval [CI], 1.50-1.87; P < .001; adjusted OR, 1.73; 95% CI, 1.32-2.26; P < .001), in-hospital mortality (OR, 1.90; 95% CI, 1.43-2.53; P < .001), limb ischemia (OR, 2.44; 95% CI, 1.73-2.43; P < .001), renal complications (OR, 1.73; 95% CI, 1.12-2.67; P = .028), cardiac complications (OR, 1.68; 95% CI, 1.01-2.80; P = .046), and long-term all-cause mortality (hazard ratio, 1.23; 95% CI, 1.09-1.38; P = .001) compared with men; however, no significant sex difference was observed for visceral/mesenteric ischemia (OR, 1.62; 95% CI, 0.91-2.88; P = .098), 30-day reinterventions (OR, 1.37; 95% CI, 0.95-1.98; P = .095), late endoleaks (OR, 1.18; 95% CI, 0.88-1.56; P = .264), and late reinterventions (OR, 1.05; 95% CI, 0.78-1.41; P = .741). In the intact AAA subgroup, women had a significantly increased risk of visceral/mesenteric ischemia (OR, 1.85; 95% CI, 1.01-3.39; P = .046) and an equivalent risk of cardiac complications (OR, 1.64; 95% CI, 0.85-3.17; P = .138) compared with men.Conclusions: Compared with male sex, female sex is associated with an increased risk of 30-day mortality, in-hospital mortality, limb ischemia, renal complications, cardiac complications, and long-term all-cause mortality after EVAR for infrarenal AAA. Women should be enrolled in a strict and regular long-term surveillance after EVAR.