Female Sex is Associated with Worse Outcomes following Complex Fenestrated or Branched Endovascular Aortic Repair.

BACKGROUND: Sex-related discrepancies after standard endovascular aneurysm repair (EVAR) are noted to disproportionally affect females. A growing body of literature suggests similar disparities may extend to complex fenestrated or branched endovascular aneurysm repair (FBEVAR). However, recent examination of complex FBEVAR by a consortium of high-volume centers noted equivalent mortality among sexes. Whether similar results extend to non-trial data is unknown. METHODS: We examined all juxta-renal through type IV thoraco-abdominal aneurysms (sealing zones 6-8) which underwent elective FBEVAR within the Vascular Quality Initiative (VQI) database from January 2012 to December 2020. Urgent, symptomatic, ruptured, and staged cases were excluded, as were parallel stent grafts. Demographics, comorbid conditions, and technical factors were compared between sexes. Univariate analysis with Wilcoxon ranked sum tests and Chi-square tests of proportion were performed, followed by multivariate logistic regression for failure of target vessel technical success, reintervention, complications, and in-hospital mortality. RESULTS: Our analysis included 1,521 patients, 1,180 males (77.6%) and 341 females (22.4%). There were noted differences in pre-operative demographics, medical optimization, and technical aspects of the procedure. However, no difference was noted in proximal or distal sealing stents, number of fenestrations, or immediate endoleaks. On a multi variate logistic regression, female sex was an independent predictor of failure of target vessel technical success (odds ratio (OR) 3.339, 95% confidence interval (CI): 2.173-5.132, P < 0.001), reintervention (OR 2.192, 95% CI: 1.304-3.683, P = 0.003), complications (OR 1.747, 95% CI: 1.282-2.381, P < 0.001), and in-hospital mortality (OR 2.836, 95% CI: 1.510-5.328, P = 0.001). CONCLUSIONS: Females suffer worse outcomes after FBEVAR despite similar extent of disease, number of fenestrations, and incidence of immediate endoleak. Notable discrepancies were higher rates of chronic obstructive pulmonary disease (COPD) and lower rates of pre-operative aspirin, statin, and beta blocker therapy in females. Controlling for pre-operative demographics, female sex remained an independent predictor of worse outcomes. These discrepancies warrant further examination and should impact case planning for female patients undergoing complex aortic aneurysm repair.

A Real-World Experience Comparison of Percutaneous and Open Femoral Exposure for Endovascular Abdominal Aortic Aneurysm Repair in a Tertiary Medical Center.

OBJECTIVE: To compare the outcomes of elective percutaneous endovascular aneurysm repair (PEVAR) versus surgical cutdown endovascular aneurysm repair (SEVAR) procedures performed at a tertiary medical center from 2012 to 2015. METHODS: This is a unique study using procedure data from two vascular surgeons who performed SEVAR in almost every case versus three vascular surgeons who performed PEVAR in all cases except when considered prohibitive on account of circumferential calcification or severe occlusive disease of the common femoral artery or some other technical consideration. Medical records of patients aged 18 years or older undergoing elective PEVAR or SEVAR between January 2012 and December 2015 were reviewed. Differences in readmissions and complications between patients who received PEVAR and those who received SEVAR were assessed using Fisher's exact test. The exact Cochran-Armitage test was used to assess trends in length of stay between the PEVAR and SEVAR group. RESULTS: A total of 183 patients were analyzed. In total, 132 underwent PEVAR and 51 underwent SEVAR. A statistically significant difference was noted with regard to 30-day readmissions (2.3% vs 13.7%, P = .006) in favor of PEVAR and categorical length of stay tended to be longer in the SEVAR group ( P = .003). The 30-day complication rate was not statistically different (6.8% vs 15.7%, P = .09). CONCLUSIONS: Surgical cutdown endovascular aneurysm repair results in more readmissions, often related to groin wound complications, which lead to prolonged length of stay and expense. Patients undergoing PEVAR tend to have a shorter length of stay. Overall complication rate was similar in the two groups. We recommend PEVAR for patients with appropriate anatomy.