Sex disparities in popliteal artery aneurysms

OBJECTIVES:Only 5% of patients with popliteal artery aneurysms (PAA) are female. Evidence on PAA treatment and outcomes in women is therefore scarce. The POPART Registry provides one of Europe's largest data collections regarding PAA treatment. Data on clinical presentation, aneurysm morphology and perioperative outcomes following open surgical PAA repair in women will be presented. METHODS:POPART is a multicenter, non-interventional registry for open and endovascular PAA repair with 42 participating centers in Germany and Luxembourg. All patients aged > 18 years who have been treated for PAA since 2010 are eligible for study inclusion. Data collection is based on an online electronic case report form. RESULTS:Of the n=1236 PAA, n=58 (4.8%) were in women. There were no significant differences in age or cardiopulmonary comorbidities. However, female patients had a lower prevalence of contralateral PAA and abdominal aortic aneurysm (p<.05). PAA in women were more likely to be symptomatic before surgery (65.5% vs 49.4%; p=.017), with 19% of women presenting with acute limb ischemia (vs 11%; p=.067). Women had smaller aneurysm diameters than men (22.5mm vs 27mm; p=.004) and became symptomatic at smaller diameters (20mm vs 26mm; p=.002). Only 8.6% of women and 11.6% of men underwent endovascular aneurysm repair (p>.05); therefore, the perioperative outcome analysis focused on open surgical repair. 23.5% of women and 16.9% of men developed perioperative complications (p>.05). There were no differences in major cardiovascular events (p>.05), but women showed a higher incidence of impaired wound healing (15.7% vs 7.2%; p=.05) and major amputation (5.9% vs 1.1%; p=.027). Female sex was significantly associated with the need for non-vascular reinterventions within 30 days after surgery (OR, 95%CI: 2.48, 1.26 - 4.88), while no significant differences in the odds for vascular reinterventions were observed (OR, 95%CI: 1.98, 0.68 - 5.77). In the multiple logistic regression model, female sex, symptomatic PAA, poor quality of outflow vessels and graft material other than vein graft were independently associated with perioperative reinterventions. CONCLUSION:Women have smaller PAAs, are more likely to be symptomatic prior to treatment, and are more often affected by non-vascular reinterventions in the perioperative course. As our understanding of aneurysmatic diseases in women continues to expand, sex-specific treatment strategies and screening options for women in well-selected cohorts with modified screening protocols should be continuously re-evaluated.