Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/S1677-54492006000200005
Jornal Vascular Brasileiro
Original Article

Tratamento cirúrgico dos aneurismas da aorta abdominal: existe diferença dos resultados entre homens e mulheres?

Surgical treatment of abdominal aortic aneurysms: is there difference in the results obtained in men and women?

Telmo Pedro Bonamigo; Márcio Luís Lucas; Nilon Erling Jr.

Downloads: 0
Views: 83

Resumo

OBJETIVO: Avaliar os resultados cirúrgicos após o tratamento convencional e eletivo do aneurisma da aorta abdominal, verificando se existe diferença entre homens e mulheres na mortalidade e morbidade cirúrgicas, bem como nos resultados a longo prazo. PACIENTES E MÉTODOS: Entre dezembro de 1983 e dezembro de 2003, 675 pacientes foram submetidos ao tratamento cirúrgico do aneurisma da aorta abdominal infra-renal, sendo divididos em dois grupos: homens (n = 575) e mulheres (n = 100). Os dados demográficos e aqueles relacionados ao procedimento cirúrgico, bem como os resultados perioperatórios, foram coletados pela revisão dos prontuários. Os pacientes com alta hospitalar formaram uma coorte retrospectiva, onde foram avaliadas as causas tardias de óbito e a sobrevida. RESULTADOS: A média das idades foi similar, sem diferença estatística entre mulheres e homens (68,9 ± 9,1 versus 67,4 ± 7,1 anos; P = 0,089). A presença de hipertensão arterial foi significativamente superior nas mulheres (73 versus 62,4%; P = 0,042), e a cardiopatia isquêmica e história de tabagismo foram mais freqüentes nos homens (P <0,05). A mortalidade operatória total foi de 2,8%, não havendo diferença significativa entre mulheres e homens (4 versus 2,6%, respectivamente; P = 0,43). A morbidade cirúrgica envolveu 14% dos pacientes femininos e 18,4% dos masculinos (P 0,05). A taxa de sobrevida global em 1, 3, 5 e 10 anos não diferiu entre os grupos, sendo a sobrevida em 5 anos de 71% para as mulheres e 72% para os homens (P 0,05). A principal causa de morte tardia foi de origem cardiovascular, seguida de complicações renais nas mulheres e neoplasia nos homens. CONCLUSÂO: A taxa de mortalidade e morbidade cirúrgicas não aumentou significativamente nas mulheres após a correção eletiva do aneurisma da aorta abdominal infra-renal. Além disso, os resultados a longo prazo são semelhantes entre os dois gêneros.

Palavras-chave

Aneurisma da aorta abdominal, cirurgia, mulheres

Abstract

OBJECTIVE: To evaluate perioperative results in patients submitted to elective conventional open repair of abdominal aortic aneurysm, comparing the results between women and men in relation to perioperative mortality and morbidity, as well as long term outcomes. PATIENTES AND METHODS: Between December 1983 and December 2003, 675 patients were submitted to infrarenal abdominal aortic aneurysm repair. We divided these patients into two groups: men (n = 575) and women (n = 100). Demographic and operative data, as well as perioperative outcomes were obtained from chart review. Discharged patients formed a retrospective cohort, in which the late causes of death and survival were evaluated. RESULTS: The mean age was similar, but no statistical difference was observed between men and women (68.9 ± 9.1 versus. 67.4 ± 7.1 years; P = 0.089). The presence of hypertension was significantly higher in women (73 versus 62.4%; P = 0.042), and coronary artery disease and history of smoking were more prevalent in men (P <0.05). The overall mortality rate was 2.8%, without any significant difference between women and men (4 versus 2.6%, respectively; P = 0.43). Perioperative morbidity was similar in both groups (14% for women; 18.4% for men; P 0.05). The survival rates in 1, 3, 5, and 10 years were similar in the groups, with a 5-year survival of 71% for women and 72% for men (P 0.05). Cardiovascular disease was the main late death cause in both groups, followed by renal complications in women and neoplasia in men. CONCLUSION: Perioperative mortality and morbidity rates did not significantly increase in women after conventional infrarenal abdominal aortic aneurysm repair. Furthermore, long term results were similar in both genders.

Keywords

Abdominal aortic aneurysm, surgery, women

References

Marrugat J, Sala J, Masia R. Mortality differences between men and women following first myocardial infarction. JAMA. 1998;280:1405-9.

Khan SS, Nessim S, Gray R, Czer LS, Chaux A, Matloff J. Increased mortality of women in coronary artery bypass surgery: evidence for referral bias. Ann Intern Med.. 1990;112:561-7.

Johnston KW. Influence of sex on the results of abdominal aortic aneurysm repair: Canadian Society for Vascular Surgery Aneurysm Study Group. J Vasc Surg.. 1994;20:914-23.

Stenbaek J, Granath F, Swedenborg J. Outcome after abdominal aortic aneurysm repair: difference between men and women. Eur J Vasc Endovasc Surg.. 2004;28:47-51.

Katz DJ, Stanley JC, Zelenock GB. Gender differences in abdominal aortic aneurysm prevalence, treatment and outcome. J Vasc Surg.. 1997;25:561-8.

Norman PE, Semmens JB, Lawrence-Brown M, Holman CD. The influence of gender on outcome following peripheral vascular surgery: a review. Cardiovasc Surg.. 2000;8:111-5.

Blanchard JF. Epidemiology of abdominal aortic aneurysms. Epidemiol Rev.. 1999;21:207-21.

Lederle FA, Johnson GR, Wilson SE. The aneurysm detection and management study screening program: validation cohort and final results. Arch Intern Med.. 2000;160:1425-30.

Lederle FA, Johnson GR, Wilson SE. Aneurysm Detection and Management Veterans Affairs Cooperative Study: Abdominal aortic aneurysm in women. J Vasc Surg.. 2001;34:122-6.

Norman PE, Semmens JB, Lawrence-Brown MM, Holman CD. Long term relative survival after surgery for abdominal aortic aneurysm in western Australia: population based study. BMJ. 1998;317:852-6.

Katz DJ, Stanley JC, Zelenock GB. Operative mortality rates for intact and ruptured abdominal aortic aneurysms in Michigan: an eleven-year statewide experience. J Vasc Surg.. 1994;19:804-15.

Dimick JB, Stanley JC, Axelrod DA. Variation in death rate after abdominal aortic aneurysmectomy in the United States: impact of hospital volume, gender and age. Ann Surg.. 2002;235:579-85.

Screening for abdominal aortic aneurysm: recommendation statement. Ann Intern Med.. 2005;142:198-202.

Bonamigo TP, Siqueira I. Screening for abdominal aortic aneurysms. Rev Hosp Clin Fac Med São Paulo.. 2003;58:63-8.

Kent K, Zwolak RM, Jaff MR. Screening for abdominal aortic aneurysm: a consensus statement. J Vasc Surg.. 2004;39:267-9.

interim results for symptomatic patients with severe (70-99%) or with mild (0-29%) carotid stenosis: European Carotid Surgery Trialists' Collaborative Group. Lancet. 1991;337:1235-43.

Maxwell J, Rutledge R, Covington DL, Churchill MP, Clancy TV. A statewide, hospital-based analysis of frequency and outcomes in carotid endarterectomy. Am J Surg.. 1997;174:655-60.

Schneider JR, Droste JS, Golan JF. Carotid endarterectomy in women versus men: patient characteristics and outcomes. J Vasc Surg.. 1997;25:890-6.

Hertzer NR, O'Hara PJ, Mascha EJ, Krajewski LP, Sullivan TM, Beven EG. Early outcome assessment for 2228 consecutive carotid endarterectomy procedures: the Cleveland Clinic experience from 1989 to 1995. J Vasc Surg.. 1997;26:1-10.

Enzler MA, Ruoss M, Seifert B, Berger M. The influence of gender on the outcome of arterial procedures in the lower extremity. Eur J Vasc Endovasc Surg.. 1996;11:446-52.

Magnant JG, Cronenwett JL, Walsh DB, Schneider JR, Besso SR, Zwolak RM. Surgical treatment of infrainguinal arterial occlusive disease in women. J Vasc Surg.. 1993;17:67-76.

Starr JE, Hertzer NR, Mascha EJ. Influence of gender on cardiac risk and survival in patients with infrarenal aortic aneurysms. J Vasc Surg.. 1996;23:870-80.

Brown LC, Powell JT. Risk factors for rupture in abdominal aortic aneurysms under surveillance: UK Small Aneurysm Trial Participants. Ann Surg.. 1999;230:289-96.

Sampaio SM, Panneton JM, Mozes GI. Endovascular abdominal aortic aneurysm repair: does gender matter?. Ann Vasc Surg.. 2004;18:653-60.

Parlani G, Verzini F, Zannetti S. Does gender influence outcome of AAA endoluminal repair?. Eur J Vasc Endovasc Surg.. 2003;26:69-73.

Mathison M, Becker GJ, Katzen BT. The influence of female gender on the outcome of endovascular abdominal aortic aneurysm repair. J Vasc Interv Radiol.. 2001;12:1047-51.

Norman PE, Semmens JB, Lawrence-Brown MM. Long-term relative survival following surgery for abdominal aortic aneurysm: a review. Cardiovasc Surg.. 2001;9:219-24.

Crawford ES, Saleh SA, Babb JW, Glaeser DH, Vaccaro PS, Silvers A. Infrarenal abdominal aortic aneurysm: factors influencing survival after operation performed over a 25-year period. Ann Surg.. 1981;193:699-7.

Soisalon-Soininen S, Salo JA, Takkunen O, Mattila S. Comparison of long term survival after repair of ruptured and non-ruptured abdominal aortic aneurysm. Vasa. 1995;24:42-8.

Evans SM, Adam DJ, Bradbury AW. The influence of gender on outcome after ruptured abdominal aortic aneurysm. J Vasc Surg.. 2000;32:258-62.

Gloviczki P, Pairolero PC, Mucha P Jr. Ruptured abdominal aortic aneurysms: repair should not be denied. J Vasc Surg.. 1992;15:851-7.

Bauer EP, Redaelli C, von Segesser LK, Turina MI. Ruptured abdominal aortic aneurysms: predictors for early complications and death. Surgery. 1993;114:31-5.

Semmens JB, Norman PE, Lawrence-Brown MM, Holman CD. Influence of gender on outcome from ruptured abdominal aortic aneurysm. Br J Surg.. 2000;87:191-4.

Johansen K, Kohler TR, Nicholls SC, Zierler RE, Clowes AW, Kazmers A. Ruptured abdominal aortic aneurysm: the Harborview experience. J Vasc Surg.. 1991;13:240-5.

Dueck AD, Kucey DS, Johnston KW, Alter D, Laupacis A. Survival after ruptured abdominal aortic aneurysm: effect of patient, surgeon, and hospital factors. J Vasc Surg.. 2004;39:1253-60.

Ouriel K, Greenberg RK, Clair DG. Endovascular aneurysm repair: gender specific results. J Vasc.. 2003;38:93-8.

5dea3f900e88256f7f2afa9e jvb Articles
Links & Downloads

J Vasc Bras

Share this page
Page Sections