Fenestrated and Branched Endovascular Aortic Arch Repair Outcomes in Female Patients: A Retrospective Multicentre Analysis.

Abstract

Data on females managed with fenestrated or branched endovascular aortic arch repair (FB-Arch) are limited. This study aimed to present the 30 day and follow up outcomes of FB-Arch in female patients. A retrospective analysis (1 January 2011 to 31 March 2024) among four European aortic centres was conducted according to STROBE guidelines. Consecutive female patients managed with custom made FB-Arch devices (Cook Medical, Bloomington, IN, USA) were eligible. Primary outcomes were technical success and death and stroke at 30 days. Kaplan-Meier and Cox regression analyses were performed for follow up outcomes. The study included 148 females (mean age 71.8 ± 3.5 years; mean aortic diameter 61.9 ± 4.2 mm; 14.2% urgent; 5.4% ruptures). The aortic dissection rate was 38.5% (35.8% chronic; 2.7% acute). Distal FB-Arch was performed in 23%. B-Arch was used in 68.9% and F-Arch in 27.7%, while 3.4% were managed with a left subclavian artery branch device. The non-native proximal aortic landing (nNPAL) rate was 60.1%. Technical success was 95.9%. The 30 day mortality rate was 8.1%, with respiratory failure (odds ratio [OR] 0.36, 95% confidence interval [CI] 0.21 - 0.50; p < .001) and pericardial effusion (OR 0.43, 95% CI 0.43 - 0.82; p < .001) being independently related. The stroke rate was 10.1% (6.1% major; all ischaemic), with peripheral arterial disease as a predictor (OR 0.20, 95% CI 0.04 - 0.39; p = .020), and nNPAL (OR -0.22, 95% CI -0.26 - -0.02; p = .030) and aortic dissection (OR -0.19, 95% CI -0.24 - -0.001; p = .040) related to lower stroke rates. Urgent repair was not related to adverse events. The spinal cord ischaemia rate was 3.4%. At 48 months (mean follow up 20.6 ± 9.4 months), survival was 79.5% (95% CI 74.7 - 84.3%), with stroke (hazard ratio [HR] 5.3, 95% CI 4.8 - 5.8; p = .002) and congestive heart failure (HR 6.1, 95% CI 5.5 - 6.6; p = .003) being related to lower survival. Freedom from unscheduled re-interventions was 53.9% (95% CI 44.5 - 63.3%) at 48 months. Female patients managed with FB-Arch presented an acceptable 30 day mortality rate. nNPAL and aortic dissection were independently related to lower stroke risk. Unscheduled re-interventions affected almost half of cases during follow up.