gms | German Medical Science

10th Munich Vascular Conference

01.-03.12.2021, online

Similar poor survival for women treated for AAA at 50 versus 55 mm thresholds – a Swedvasc Study

Meeting Abstract

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10th Munich Vascular Conference. sine loco [digital], 01.-03.12.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. Doc34

doi: 10.3205/21mac34, urn:nbn:de:0183-21mac343

Veröffentlicht: 22. Dezember 2021

© 2021 Talvitie et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe



Background: There is a challenging balance in contemporary vascular practice when evaluating women for abdominal aortic aneurysm (AAA) repair: the increased mortality among women undergoing repair and the higher rupture rate under surveillance. The aim of this national Swedvasc-based study was to determine whether mortality differs among women treated at 50 mm versus 55 mm, while taking comorbid conditions and treatment method into consideration.

Methods: All women ≥45 years of age with scheduled elective repair for asymptomatic AAA ≥49 mm in Sweden 2008-2018 were identified in the Swedish National Registry for Vascular Surgery, Swedvasc ( Mortality rates at 30 & 90 days, 2 & 5 years after the index procedure were assessed. Overall survival until end of follow-up (June 2021) was also analyzed. Multiple logistic regression for 90-day and 5-year mortality yielded odds ratios adjusted (aOR) for age, size at repair (small vs. large), heart disease, chronic obstructive pulmonary disease (COPD), cerebrovascular disease, diabetes, smoking and treatment modality (endovascular [EVAR] vs. open).

Results: During this 11-year period, 1182 women were identified, 375 (32%) with small aneurysms (<55mm) and 807 with larger aneurysms (≥55 mm, 68%). The proportion of small aneurysms during the study period was stable (32%, p=0.90). Women with small aneurysms were younger (73 vs. 75 years, p<0.001); all other risk factors were evenly distributed. EVAR was used in 61% (63% among small vs. 60% among large AAAs, p=0.32). The proportion of EVAR-treated women increased over time (53% in 2008-2010 to 65% in 2015-2018). Median survival was 7.4 years: 7.9 and 7.1 among women with small and large AAAs, respectively (p=0.002). Mortality at 30 & 90 days, 2 & 5 years was not different for women in the two size groups (1.9% vs. 3.6%, p=0.15; 3.2% vs. 4.7%, p=0.30; 9.9% vs. 13.8%, p=0.07; 25.6% vs. 31.0%, p=0.1). In the multivariate regression analysis for 90-day mortality, EVAR and COPD influenced the risk but not aneurysm size (aORs with 95% CIs for aneurysm size 1.36 [0.69-2.66], p=0.38; EVAR 0.51 [0.28-0.93], p=0.03; COPD 2.01 (1.11-3.66), p=0.02). At 5 years, increasing age, EVAR and COPD increased the odds of mortality, unlike size at repair (aORs and 95% CIs for aneurysm size 1.18 [0.86-1.62], p=0.31; age 1.05 [1.03-1.08], p<0.001; EVAR 1.69 [1.24-2.31], p<0.001; COPD 1.38 [1.01-1.90], p=0.04).

Conclusion: The clinical challenge when facing a woman with a 50 mm AAA is to determine whether the rupture risk under surveillance outweighs the surgical mortality risk. These data suggest that treated women suffer high mortality rates up to five years, irrespective of AAA size at repair. Surgical thresholds among women must be evaluated in an RCT in order to confirm that the increased rupture risk between 50 and 55 mm indeed justifies a lowered treatment threshold for women. This is especially true considering the low gain in overall mortality, as indicated in this national study.