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

IF 5.7 1区医学 Q1 PERIPHERAL VASCULAR DISEASE European Journal of Vascular and Endovascular Surgery Pub Date : 2024-09-01 DOI:10.1016/j.ejvs.2024.04.030

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Abstract

Objective

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.

Methods

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.

Results

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).

Conclusion

Both sexes presented similar outcomes after F/B-Arch. Appropriate patient selection may decrease the effect of sex in F/B-Arch outcomes.

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分支式和瓣膜式主动脉弓修复术疗效的性别比较分析

目的女性性别是血管内主动脉修复术后不良事件的一个风险因素。方法根据 STROBE 对连续接受 F/B-Arch 治疗的患者进行单中心回顾性性别比较分析。主要结果是技术成功率、死亡和30天内脑血管发病率的性别比较。随访结果采用 Kaplan-Meier 估计值。冠状动脉疾病（p < .001）和既往心肌梗死（p = .01）在女性中更为常见。女性非原发性主动脉近端着床率较高（女性：51.3%；男性：31.8%，p = .005），主动脉夹层率较低（28.8% vs. 48.1%，p = .005）。近端着陆到石丸区没有差异（0区：p = .18；1区：p = .47；2区：p = .39）。移植物配置分布均匀。总共桥接了 416 条主动脉上干。每位患者血管再通次数的中位数为 2 次（四分位间范围为 1-3 次），性别间无差异（p = .54）。技术成功率（女性：97.5%；男性：96.9%，p = .80）、30 天死亡率（女性：10%；男性：9.3%，p = .86）和脑血管发病率（女性：11.3%；男性：17.1%，p = .25）相似。女性出现更多与入路相关的并发症（女性：32.5%；男性：16.3%，p = .006），但不影响与入路相关的再干预（p = .55）。12个月后的存活率（女性：81.1%，95% 置信区间[CI] 76.3 - 85.9%；男性：79.8%，95% 置信区间[CI] 76.0 - 83.6%）和无再介入率（女性：56.6%，95% 置信区间[CI] 50.4 - 62.8%；男性：55.3%，95% 置信区间[CI] 50.1 - 60.5%）相似（对数秩分别为 p = .40 和 p = .41）。适当选择患者可减少性别对 F/B-Arch 术后效果的影响。

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来源期刊

European Journal of Vascular and Endovascular Surgery 医学-外科

CiteScore

6.80

自引率

15.80%

发文量

471

审稿时长

66 days

期刊介绍： The European Journal of Vascular and Endovascular Surgery is aimed primarily at vascular surgeons dealing with patients with arterial, venous and lymphatic diseases. Contributions are included on the diagnosis, investigation and management of these vascular disorders. Papers that consider the technical aspects of vascular surgery are encouraged, and the journal includes invited state-of-the-art articles. Reflecting the increasing importance of endovascular techniques in the management of vascular diseases and the value of closer collaboration between the vascular surgeon and the vascular radiologist, the journal has now extended its scope to encompass the growing number of contributions from this exciting field. Articles describing endovascular method and their critical evaluation are included, as well as reports on the emerging technology associated with this field.