BACKGROUND: This study aimed to determine the outcomes of survival, endoleaks, reinterventions, and perioperative mortality rate (PMR) in patients with abdominal aortoiliac aneurysms (AAIA) receiving endovascular or open surgical repair with respect to sex, with two groups of patients being evaluated: male and female. METHODS: This was a prospective, single-centered, consecutive cohort study of patients with AAIA who underwent endovascular treatment or open surgical repair regarding gender. Two groups of patients were evaluated: the male group and the female group. RESULTS: A total of 160 patients underwent open or endovascular surgery, with two groups as follows: male (128 patients, 80%) and female (32 patients, 20%). The clinical characteristics were similar between the two groups, except for a higher prevalence of diabetes in the male group than in the female group (50.8% vs. 9.4%, P <
0.001) and cardiac disease in the male group than in the female group (23.4% vs. 3.1%, P = 0.004). The PMR was 6.9% in 11 patients, which was higher in the female group (4 patients, 12.5%) than in the male group (7 patients, 5.5%
P = 0.027). The reintervention rates were 13.2% (21 cases) in the total cohort, higher in the female group, seven patients (21.9%) than in the male group (14 patients [11%], P = 0.036). The overall survival in a Kaplan-Meier at 720 days was 89.8% in the male group and 84.4% in the female group, but the difference was not statistically significant among the groups (P = 0.33). The time freedom from reintervention at 720 days was 90.9% in the male group and 76.9% in the female group (P = 0.022). CONCLUSION: In the present study, female patients had higher rates of reintervention and perioperative mortality than male patients. The main factors associated with death were bowel ischemia, chronic kidney disease, and elevated cardiac risk. Moreover, the main factors related to the reintervention rates were female sex and endoleaks.