(PC154) Female sex is associated with increased risk of early mortality and life-altering events among 6316 patients treated for complex aortic aneurysms in the International Multicenter Aortic Research Group

Objectives: To investigate sex-related differences in early outcomes after fenestrated-branched endovascular aneurysm repair (FB-EVAR) among patients treated for complex abdominal aortic aneurysms (CAAAs) and thoracoabdominal aortic aneurysms (TAAAs).

Methods: The clinical data of consecutive patients treated by FB-EVAR for CAAAs or TAAAs at 29 aortic centers in North America, Europe, and New Zealand (2006-2024) was retrospectively reviewed (2006-2024). Primary endpoint was incidence of 30-day or in-hospital mortality. Secondary endpoints were TAAA life-altering event (TALE; death, permanent spinal cord injury [SCI], permanent dialysis, or major stroke), any major adverse event (MAE; any cause mortality, acute kidney injury [AKI], SCI, respiratory failure, major stroke, myocardial infarction, bowel ischemia), and non-home (NH) hospital discharge.

Results: There were 6,316 patients (4,582 males, 1,734 females; mean age 72.448.49 years-old) treated by FB-EVAR for 1,845 (29.2%) CAAAs and 4,471 (70.8%) TAAAs. Female patients had smaller aneurysms (63.811.8 vs. 66.313.6mm; P <.001), higher prevalence of TAAAs (82.5% vs 66.4%; P <.001) and Crawford extent I-III TAAAs (79.2% vs 62.6%; P <.001). Technical success was lower among female patients (93.9% vs 96.5%; P <.001). Female patients had significantly higher rates of early mortality (6.1% vs 4.2%; P<.001), MAEs (21.7% vs 18.1%; P=.001), TALE (10.9% vs 8.0%; P <.001), respiratory failure (4.3% vs 3.1%; P=.017), major stroke (2.5% vs 1.5%; P=.005), SCI (9.4% vs 6.6%; P <.001) and permanent SCI (4.1% vs 2.8%; P=0.008). Women also received NH hospital discharge more often (24.7% vs 14.2%; P<.001). Female patients had higher incidences of early mortality, TALE, and SCI in the TAAA group, but not in the CAAA group (Table I). Female sex was independently associated with increased risk for early mortality in the entire cohort (odds ratio: 1.49, confidence interval: 1.14-1.96; P =.004) after controlling for aneurysm extent, maximum aneurysm diameter, symptomatic aneurysms, coronary artery disease, age, smoking history, and chronic kidney disease. Among patients with TAAAs, female sex was independently associated with increased risk of early mortality and TALE.

Conclusions: Female sex is associated with lower technical success, higher early mortality, higher risk of complications including TALE, and higher rates of non-home hospital discharge among patients treated by FB-EVAR. The negative effect of female sex on adverse outcomes is noted among patients with more extensive TAAAs. Female sex is not associated with higher mortality and complication rates among patients with less extensive CAAAs, emphasizing the importance of aneurysm extent stratification when describing outcomes of FB-EVAR.