Incidence, predictive factors, and outcomes of intra-procedure adverse events during fenestrated-branched endovascular aortic repair of complex abdominal and thoracoabdominal aortic aneurysms.

Abstract Objectives To evaluate the incidence of intraoperative adverse events (IAEs) and their impact on outcomes after fenestrated-branched endovascular aortic repair (FB-EVAR) of complex abdominal aortic aneurysms (CAAAs) and thoracoabdominal aortic aneurysm (TAAAs). Methods We reviewed the clinical and imaging data of 600 consecutive patients (445 male mean age of 75±8 years-old) who underwent FB-EVAR between 2007 and 2019 in a single institution. IAE was defined as any intraoperative complication or technical problem requiring additional and unplanned procedures, and was classified in access-related, target artery (TA)-related or graft-related. End-points included rates of IAEs, 30-day or in-hospital mortality, major adverse events (MAEs), patient survival, freedom from secondary intervention and TA instability. Results A total of 122 IAE were identified in 105 patients (18%). IAE were TA-related in 55 patients (9%), access-related in 46 patients (8%) and graft-related in seven patients (1%). Female sex was more frequent among IAE patients (44% vs. 22%, p 50% (OR 2.0, 95% CI 1.3-3.3), and Crawford Extent II TAAA (OR 1.9, 95% CI 1.1-3.3) were predictive of IAEs whereas preloaded design (OR 0.6, 95% CI 0.4-0.9) and TA diameter (+1mm, OR 0.6, 95% CI 0.4-0.9) were protective of IAEs. IAE affected negatively secondary intervention (HR: 1.6, 95% CI: 1.1-2.3) and TA instability (HR: 2.5, 95% CI: 1.2-5.4), however, did not affect patient survival (HR: 1.0, 95% CI: 0.7 – 1.4). Conclusions IAEs are common, occurring in nearly one out of five patients treated by FB-EVAR for complex aortic aneurysms, and have a negative impact on clinical outcomes. IAEs were associated with female sex, TA diameter and more extensive aortic disease.