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

Nana, Petroula ; Haulon, Stéphan ; Tsilimparis, Nikolaos ; Le Houérou, Thomas ; Bastianon, Martina ; Karelis, Angelos LU orcid ; Dias, Nuno LU orcid and Kölbel, Tilo LU (2025) In European Journal of Vascular and Endovascular Surgery 70(1). p.69-77
Abstract

OBJECTIVE: 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.

METHODS: 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.

RESULTS: The study included 148 females (mean age 71.8 ± 3.5 years; mean aortic diameter 61.9 ± 4.2... (More)

OBJECTIVE: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSION: 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.

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Contribution to journal
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published
subject
keywords
Aged, Aged, 80 and over, Female, Humans, Middle Aged, Aorta, Thoracic/surgery, Aortic Aneurysm, Thoracic/surgery, Aortic Dissection/surgery, Blood Vessel Prosthesis, Blood Vessel Prosthesis Implantation/adverse effects, Endovascular Procedures/adverse effects, Europe/epidemiology, Postoperative Complications/epidemiology, Prosthesis Design, Retrospective Studies, Risk Factors, Stroke/epidemiology, Time Factors, Treatment Outcome
in
European Journal of Vascular and Endovascular Surgery
volume
70
issue
1
pages
69 - 77
publisher
Elsevier
external identifiers
  • pmid:40127885
  • scopus:105004350605
ISSN
1532-2165
DOI
10.1016/j.ejvs.2025.03.021
language
English
LU publication?
yes
additional info
Copyright © 2025 The Author(s). Published by Elsevier B.V. All rights reserved.
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9507ea38-f54d-4845-9e46-49ca408cecbd
date added to LUP
2025-08-17 14:19:44
date last changed
2025-08-19 13:32:56
@article{9507ea38-f54d-4845-9e46-49ca408cecbd,
  abstract     = {{<p>OBJECTIVE: 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.</p><p>METHODS: 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.</p><p>RESULTS: 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 &lt; .001) and pericardial effusion (OR 0.43, 95% CI 0.43 - 0.82; p &lt; .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.</p><p>CONCLUSION: 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.</p>}},
  author       = {{Nana, Petroula and Haulon, Stéphan and Tsilimparis, Nikolaos and Le Houérou, Thomas and Bastianon, Martina and Karelis, Angelos and Dias, Nuno and Kölbel, Tilo}},
  issn         = {{1532-2165}},
  keywords     = {{Aged; Aged, 80 and over; Female; Humans; Middle Aged; Aorta, Thoracic/surgery; Aortic Aneurysm, Thoracic/surgery; Aortic Dissection/surgery; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation/adverse effects; Endovascular Procedures/adverse effects; Europe/epidemiology; Postoperative Complications/epidemiology; Prosthesis Design; Retrospective Studies; Risk Factors; Stroke/epidemiology; Time Factors; Treatment Outcome}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{69--77}},
  publisher    = {{Elsevier}},
  series       = {{European Journal of Vascular and Endovascular Surgery}},
  title        = {{Fenestrated and Branched Endovascular Aortic Arch Repair Outcomes in Female Patients : A Retrospective Multicentre Analysis}},
  url          = {{http://dx.doi.org/10.1016/j.ejvs.2025.03.021}},
  doi          = {{10.1016/j.ejvs.2025.03.021}},
  volume       = {{70}},
  year         = {{2025}},
}