Perioperative and Long-term Results of Zenith Fenestrated Aortic Repair in Women

Abstract

Inferior perioperative outcomes for women receiving major vascular surgery are well established in the literature in multiple arterial distributions. Therefore, this study was completed to determine the perioperative and durability results associated with women undergoing complex aortic reconstruction using the Zenith Fenestrated platform (ZFEN; Cook Medical, Bloomington, IN). A retrospective review of a fenestrated endovascular aortic repair (FEVAR) database capturing all ZFENs performed at our institution between October 2012 and March 2019 was completed. Preoperative, intraoperative, perioperative, and follow-up outcomes were tabulated for females and compared with their male counterparts. Within our study period, 136 total ZFEN procedures were performed; of which, 20 devices (14.7%) were implanted in women. Intraoperatively, we observed a higher rate of estimated blood loss (660.0mL vs. 311.6mL, P<0.01) and resultant need for transfusion (1.4 vs. 0.3 units, P<0.01) in women despite a similar frequency of brachial (5.0% vs. 7.8%, P>0.99) and femoral artery cutdowns (55.0% vs. 49.1%, P=0.81). Operative (295.7min vs. 215.7mins, P<0.01) and fluoroscopy (84.3 vs. 58.7min, P<0.01) times were also significantly higher in females than those in their male counterparts. In the perioperative (30-day) period, we observed significantly longer length of stay (5.6days vs. 3.3days, P=0.03) and continued need for transfusion (50% vs. 9.5%, P<0.01) in women. Statistical trends favoring men were also noted with respect to all-cause mortality, reintervention, visceral stent thrombosis, renal failure, acute kidney injury, and respiratory failure. After a mean follow-up of nearly 2 years, we found no differences in late all-cause or aneurysm-related mortality, major adverse cardiovascular events, or need for reinterventions. The implantation of ZFEN in females is significantly more difficult than that in their male counterparts and may result in increased perioperative, but not necessarily long-term, complications.