BackgroundThoracic endovascular aortic repair (TEVAR) is increasingly used to treat aortic dissections and aneurysms. Access-related complications remain a common source of morbidity and mortality following TEVAR. Therefore, this study aims to determine major risk factors predicting postoperative access complications and 3-year survival in patients with access complications.MethodsWe identified all patients undergoing TEVAR in the Vascular Quality Initiative from July 2010 to August 2021, excluding those converted to open repair. We defined access complication as postoperative occlusion, wound infection, hematoma, or unplanned conversion to open cutdown. The primary outcome was 3-year survival and the secondary outcome was postoperative mortality. Mixed effects logistic regression modelling with physician level clustering was used to identify factors associated with access complications and postoperative mortality. Kaplan-Meier estimates and Cox proportional hazards models were used for analysis of three-year survival.ResultsOf 18,172 patients, 1584 (8.7%) had access complications. Bilateral percutaneous access was obtained in 68% of patients, one percutaneous and one open in 14%, and bilateral open access in 13%. Patients with access complications were older (70 ± 0.6 years vs 66 ± 0.2 years; P < .01) and female (50% vs 34%; P < .01). Patients with access complications experienced higher postoperative mortality (12% vs 4.6%; P < .01), major adverse cardiac event (17% vs 6.6%; P < .01), reintervention (22% vs 10%; P < .01), and spinal ischemia (7.0% vs 2.1%; P < .01). After adjustment, factors associated with access complication include female sex (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.9-2.6; P < .01) and obesity (OR, 1.2; 95% CI, 1.0-1.4; P = .02). Access complication was independently associated with postoperative mortality (OR, 2.5; 95% CI, 2.0-3.0; P < .01). Bilateral cutdown was associated with lower mortality in male patients (OR, 0.55; 95% CI, 0.34-0.90; P = .02), but not in female patients (OR, 2.1; 95% CI, 1.1-4.3; P = .03). Last, access complications were associated with higher 3 -year mortality (hazard ratio, 1.6; 95% CI, 1.3-1.8; P < .01).ConclusionsAccess complications when unexpected are associated with adverse postoperative and three-year outcomes. Female sex is associated with higher rates of access complications, suggesting the need for devices tailored to female anatomy. BackgroundThoracic endovascular aortic repair (TEVAR) is increasingly used to treat aortic dissections and aneurysms. Access-related complications remain a common source of morbidity and mortality following TEVAR. Therefore, this study aims to determine major risk factors predicting postoperative access complications and 3-year survival in patients with access complications. Thoracic endovascular aortic repair (TEVAR) is increasingly used to treat aortic dissections and aneurysms. Access-related complications remain a common source of morbidity and mortality following TEVAR. Therefore, this study aims to determine major risk factors predicting postoperative access complications and 3-year survival in patients with access complications. MethodsWe identified all patients undergoing TEVAR in the Vascular Quality Initiative from July 2010 to August 2021, excluding those converted to open repair. We defined access complication as postoperative occlusion, wound infection, hematoma, or unplanned conversion to open cutdown. The primary outcome was 3-year survival and the secondary outcome was postoperative mortality. Mixed effects logistic regression modelling with physician level clustering was used to identify factors associated with access complications and postoperative mortality. Kaplan-Meier estimates and Cox proportional hazards models were used for analysis of three-year survival. We identified all patients undergoing TEVAR in the Vascular Quality Initiative from July 2010 to August 2021, excluding those converted to open repair. We defined access complication as postoperative occlusion, wound infection, hematoma, or unplanned conversion to open cutdown. The primary outcome was 3-year survival and the secondary outcome was postoperative mortality. Mixed effects logistic regression modelling with physician level clustering was used to identify factors associated with access complications and postoperative mortality. Kaplan-Meier estimates and Cox proportional hazards models were used for analysis of three-year survival. ResultsOf 18,172 patients, 1584 (8.7%) had access complications. Bilateral percutaneous access was obtained in 68% of patients, one percutaneous and one open in 14%, and bilateral open access in 13%. Patients with access complications were older (70 ± 0.6 years vs 66 ± 0.2 years; P < .01) and female (50% vs 34%; P < .01). Patients with access complications experienced higher postoperative mortality (12% vs 4.6%; P < .01), major adverse cardiac event (17% vs 6.6%; P < .01), reintervention (22% vs 10%; P < .01), and spinal ischemia (7.0% vs 2.1%; P < .01). After adjustment, factors associated with access complication include female sex (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.9-2.6; P < .01) and obesity (OR, 1.2; 95% CI, 1.0-1.4; P = .02). Access complication was independently associated with postoperative mortality (OR, 2.5; 95% CI, 2.0-3.0; P < .01). Bilateral cutdown was associated with lower mortality in male patients (OR, 0.55; 95% CI, 0.34-0.90; P = .02), but not in female patients (OR, 2.1; 95% CI, 1.1-4.3; P = .03). Last, access complications were associated with higher 3 -year mortality (hazard ratio, 1.6; 95% CI, 1.3-1.8; P < .01). Of 18,172 patients, 1584 (8.7%) had access complications. Bilateral percutaneous access was obtained in 68% of patients, one percutaneous and one open in 14%, and bilateral open access in 13%. Patients with access complications were older (70 ± 0.6 years vs 66 ± 0.2 years; P < .01) and female (50% vs 34%; P < .01). Patients with access complications experienced higher postoperative mortality (12% vs 4.6%; P < .01), major adverse cardiac event (17% vs 6.6%; P < .01), reintervention (22% vs 10%; P < .01), and spinal ischemia (7.0% vs 2.1%; P < .01). After adjustment, factors associated with access complication include female sex (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.9-2.6; P < .01) and obesity (OR, 1.2; 95% CI, 1.0-1.4; P = .02). Access complication was independently associated with postoperative mortality (OR, 2.5; 95% CI, 2.0-3.0; P < .01). Bilateral cutdown was associated with lower mortality in male patients (OR, 0.55; 95% CI, 0.34-0.90; P = .02), but not in female patients (OR, 2.1; 95% CI, 1.1-4.3; P = .03). Last, access complications were associated with higher 3 -year mortality (hazard ratio, 1.6; 95% CI, 1.3-1.8; P < .01). ConclusionsAccess complications when unexpected are associated with adverse postoperative and three-year outcomes. Female sex is associated with higher rates of access complications, suggesting the need for devices tailored to female anatomy. Access complications when unexpected are associated with adverse postoperative and three-year outcomes. Female sex is associated with higher rates of access complications, suggesting the need for devices tailored to female anatomy.