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

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.