Females experience elevated early morbidity and mortality but similar midterm survival compared to males after branched/ fenestrated endovascular aortic aneurysm repair

Objective: The objective of this study was to identify sex-related differences in outcomes following branched and/or fenestrated endovascular aortic repair (B/FEVAR) for thoracoabdominal (TAAA) and juxtarenal (JRAA) aortic aneurysms. Methods: Chart review completed on 242 B/FEVAR patients (57 female; 23.5%) between 2007 and 2020 at a single center. Median follow-up time was 3.3 years (interquartile range [IQR], 1.6-5.3 years). Results: No statistically significant differences in age (females, 75.9 +/- 5.4 years vs males, 74.7 +/- 7.2 years; P = .162) or aneurysm size (64.9 +/- 6.8 vs 65.8 +/- 9.4 mm; P = .41) at presentation were observed between sexes. Females presented with fewer JRAAs (45.6% vs 73%; P < .001) and received more Crawford extent II (26.3% vs 10.8%; P =.004) TAAA coverage. Increased incidence of moderate/severe target vessel stenosis (29.8% vs 14%; P = .022) was observed in female patients. Intraoperatively, females had higher procedure times (530 [IQR, 425-625] vs 420 [IQR, 350-510] minutes; P < .001), fluo-roscopy times (124.1 +/- 49 vs 107.3 +/- 43.5 minutes; P = .017), and contrast usage (200 [IQR, 150-270] vs 175 [IQR, 130-225] mL; P = .005). Unplanned intraoperative maneuvers (45.6% vs 28.1%; P = .043), graft delivery issues (24.6% vs 4.9%; P < .001), and additional intraoperative complications (61.4% vs 35.7%; P < .001) were also increased in females. Postoperatively, females had a longer intensive care unit (3 [IQR, 1-5] vs 1 [IQR, 1-3] days; P = .002) and hospital stay (8 [IQR, 5-13] vs 5 [IQR, 3-9] days; P < .001) and experienced increased rates of spinal cord ischemia (15.8% vs 3.8%; P = .001) and bowel ischemia (10.5% vs 2.7%; P = .013). In-hospital mortality (12.3% vs 2.7%; P = .004) was higher in female patients but midterm (6-year) survival was 60.2% for all patients (95% confidence interval, 53.0%-68.5%) and was similar between sexes (hazard ratio, 0.95; P = .83), which were the primary endpoints. No sex differences in midterm follow-up reintervention, endoleak, and rupture rates were observed. Conclusions: Females experienced significantly higher B/FEVAR intraoperative times, complications, and in-hospital morbidity and mortality compared with males but similar midterm outcomes. Anatomic and atherosclerotic differ-ences may have contributed to the observed in-hospital differences. (J Vasc Surg 2023;77:1349-58.)

Automated summary

The objective of this study was to identify sex-related differences in outcomes following B/FEVAR for TAAA and JRAA. The results showed that female patients had longer procedure times, more complications, and higher in-hospital mortality compared to males, but similar midterm outcomes.