Sex Comparative Analysis of Branched and Fenestrated Endovascular Aortic Arch Repair Outcomes

Abstract

Female sex is a risk factor for adverse events after endovascular aortic repair. Sex comparative early and midterm outcomes of fenestrated and branched endovascular aortic arch repair (F/B-Arch) are presented. A single centre retrospective sex comparative analysis of consecutive patients managed with F/B-Arch was conducted according to STROBE. Primary outcomes were sex comparative technical success, death, and cerebrovascular morbidity at 30 days. Kaplan-Meier estimates were used for follow up outcomes. Among 209 patients, 38.3% were women. Coronary artery disease (p < .001) and previous myocardial infarction (p= .01) were more common in women. Non-native proximal aortic landing was higher in women (women: 51.3%; men: 31.8%, p= .005) and the aortic dissection rate was lower (28.8% vs. 48.1%, p= .005). Proximal landing to Ishimaru zones showed no difference (zone 0: p= .18; zone 1: p= .47; zone 2: p= .39). Graft configurations were equally distributed. In total, 416 supra-aortic trunks were bridged. The median number of revascularisations per patient was two (interquartile range 1, 3), with no difference between sexes (p= .54). Technical success (women: 97.5%; men: 96.9%, p= .80), 30 day mortality rate (women: 10%; men: 9.3%, p= .86), and cerebrovascular morbidity (women: 11.3%; men: 17.1%, p= .25) were similar. Women presented more access related complications (women: 32.5%; men: 16.3%, p= .006), without affecting access related re-interventions (p= .55). Survival (women: 81.1%, 95% confidence interval [CI] 76.3 - 85.9%; men: 79.8%, 95% CI 76.0 - 83.6%) and freedom from re-intervention (women: 56.6%, 95% CI 50.4 - 62.8%; men: 55.3%, 95% CI 50.1 - 60.5%) at 12 months were similar (log rank, p= .40 and p= .41, respectively). Both sexes presented similar outcomes after F/B-Arch. Appropriate patient selection may decrease the effect of sex in F/B-Arch outcomes.