Endovascular versus open repair for aortoiliac occlusive disease - nationwide in-hospital outcomes by sex.

Authors

Jonas Salm, Tanja Böhme, Elias Noory, Lucas Bacmeister, Constantin von Zur Mühlen, Dirk Westermann, Thomas Zeller, Klaus Kaier

Published in

VASA. Zeitschrift fur Gefasskrankheiten. Oct 13, 2026. Epub Oct 13, 2026.

Abstract

Background: Evidence comparing endovascular therapy and open surgery for aorto-iliac occlusive disease remains limited, particularly for early complications, resource use, and sex-specific outcomes. Patients and methods: We conducted a retrospective nationwide cohort study using the 2023 German inpatient dataset. Adult hospitalisations with major endovascular or open aorto-iliac reconstructive procedures and arterial occlusive disease were included. Hospitalisations with aneurysm, dissection, or combined procedure codes were excluded. Outcomes included in-hospital mortality, myocardial infarction, ischaemic stroke, major adverse cardiovascular and cerebrovascular events (MACCE), complications, length of stay, and reimbursement. Adjusted estimates were obtained employing a doubly robust estimator using machine learning algorithms and were stratified by sex. Results: Among 2,710 hospitalisations, 1,923 (71.0%) underwent open surgery and 787 (29.0%) endovascular therapy; 41.3% involved women. Endovascular therapy was associated with lower adjusted risks of in-hospital mortality (RR .44, 95% CI .31-.64), MACCE (RR .47, 95% CI .34-.64), acute kidney injury (RR .38, 95% CI .29-.50), major bleeding (RR .36, 95% CI .25-.51), prolonged ventilation (RR .28, 95% CI .18-.43), and SAEs (RR .46, 95% CI .33-.65). Length of stay was shorter after endovascular therapy (-8.57 days, 95% CI -9.63 to -7.52), while reimbursement did not differ significantly. Sex-stratified estimates were more pronounced in men but exploratory without interaction testing. Conclusions: Endovascular therapy was associated with lower in-hospital morbidity and mortality and shorter hospital stay than open surgery, with similar reimbursement. Case-based data lacked longitudinal follow-up and detailed clinical, anatomical and treatment-selection information, limiting causal and patient-level interpretation.

PMID:
42865145
Bibliographic data and abstract were imported from PubMed on 13 Oct 2026.

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