Sex-related mid-term outcomes after fenestrated and branched endovascular repair for complex aortic aneurysms
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Deveze E.
Maurel-Desanlis B.
Nana P.
Le Houerou T.
Penetta F.F.
Mastracci T.M.
Haulon S.
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2026
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OBJECTIVE: To compare the mid-term outcomes after fenestrated and branched endovascular repair in male and female patients and to assess factors associated with sex-related outcomes. METHOD(S): Data from 423 patients who underwent fenestrated and/or branched endovascular repair (f/bEVAR) between 2016 and 2021 in two aortic centers for degenerative aneurysm or post dissection involving the thoracoabdominal aorta and pararenal aorta were retrospectively collected. The cohort was dichotomized according to sex and sex-related outcomes following f/bEVAR were assessed. Cases managed for type I to III TAAAs were analyzed separately from type IV and pararenal. The implanted devices were custom-made devices (COOK Medical, Bloomington, USA) or off-the shelf t-branch (COOK Medical). RESULT(S): Among 423 patients included, 73 (17.3%) were female. Female patients had more extensive disease with 50.7% treated for type II/III thoracoabdominal aneurysms compared to 23.1% in male patients, consequently female patients were more frequently treated with branched grafts. The estimated freedom from aorta-related mortality at 12 and 36 months was 99.1% and 93.4% in females, and 98.6% and 95.7% in males respectively (log rank p=0.401). In multivariate analysis, female sex remained not associated with aortic related mortality (HR 0.62, 95% CI 0.20-1.91, p=0.41) Freedom from aortic-related intervention at 12 and 36 months was 95.7% and 66.3% in females, and 92.9% and 72.6% in males respectively (log rank p=0.588). Sex was not significantly associated with target vessel instability after multivariate analysis (HR 1.28, 95%CI 0.63-2.57, p=0.497). Major adverse events (MAEs) were more frequent among female patients (9.5% vs 2.6%, p=0.004) with higher rate of myocardial infarction, acute renal failure with dialysis and spinal cord ischemia. In multivariate logistic regression, female sex remained independently associated with higher risk of MAEs (OR 0.222, 95% CI 0.066-0.752, p=0.015). In adjusted analysis, no independent association between sex and either device or procedure related complications was observed. The extent of aneurysm was not significantly associated with MAEs (HR 1.137, 95%CI 0.359-3.598, p=0.828). CONCLUSION(S): Female sex was independently associated with a higher risk of major adverse events, while aneurysm-related mortality and rates of aortic reintervention were comparable between males and females at a mid-term follow-up after fenestrated and branched endovascular aortic repair.Copyright © 2026 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.
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Journal of vascular surgery