Sex related outcomes after fenestrated and branched endovascular repair.

Introduction: Sex discrepancies in outcomes after fenestrated and branched endovascular repair (FBEVAR) have recently been reported, with female sex being an independent predictor for worse perioperative outcomes. The aim of this study was to investigate sex-related outcomes after complex aortic aneurysm repair and factors associated with target vessel instability (TVI).

Methods: Retrospective analysis of a prospectively maintained database of patients treated with FBEVAR at a single tertiary centre between January 2016 and December 2022. The primary endpoint was sex-specific morbidity at 30 days and target vessel instability after FBEVAR during follow-up. The secondary endpoint was factors independently associated with target vessel instability during follow-up.

Results: 169 patients were included: 21 (12.4%) females and 148 (87.6%) males, mean age of 72.3±9.6 and 73.0±8.9 years, respectively. 30-day mortality was 1 patient in each group (4.7% vs 0.6% P=0.23). During the study period, deaths occurred in 4 (19.0%) females (including 1 aorta-related death) and 39 (26.4%) males (including 8 aorta-related deaths) (p=0.81). The global cumulative incidence of TVI was 2.2% (95%CI 1.2-3.8%) at 1 year, 6.3% (95%CI 4.3-9.0%) at 2 years and 10.5% (95% CI 7.7-14.3%) at 5 years with no significant differences between males and females. In multivariate analysis, longer stent length was independently associated with TVI for left renal artery (LRA) and superior mesenteric artery (SMA), thoracoabdominal aneurysm for right renal artery (RRA) and previous endovascular surgery for SMA.

Conclusion: Similar results were reported for male and female after FBEVAR, with sex having no significant effect on TVI. Longer stent length, thoracoabdominal aneurysm rather than pararenal, FEVAR rather than BEVAR and previous endovascular surgery were factors independently associated with target vessel instability.