Sex-Based Outcomes Following Fenestrated Endovascular Aortic Repair With the Anaconda Stent Graft

Although women are less frequently affected by abdominal aortic aneurysms (AAAs), they experience significantly worse outcomes following endovascular aneurysm repair (EVAR). The fenestrated Anaconda endograft was developed to address complex aortic anatomy and may mitigate sex-based disparities in outcomes. This study evaluates sex-specific results following fenestrated EVAR (FEVAR) with the Anaconda device.

A retrospective single-centre cohort study was conducted including patients who underwent elective FEVAR using the Anaconda stent graft between 2013 and 2023. Primary endpoints were overall survival and freedom from aneurysm-related mortality. Secondary endpoints included technical success, procedure-related complications, graft patency, endoleak occurrence, and reintervention rates.

One hundred six patients (24 females and 82 males) with a median follow-up of 24 months were analysed. Female patients had lower overall mortality without statistical significance (16.7% vs 25.9%, P = .311). There was no significant difference in freedom from aneurysm-related mortality between female and male patients (4.3% vs 0%, respectively; P = .511). Technical success was slightly higher in females (95.8% vs 91.4%, P = .700), while perioperative complication rates were comparable between sexes. Myocardial infarction occurred in 0% of female patients versus 1.2% of males (P = 1.000), stroke: 0% versus 0% (P = NA), and permanent paraplegia: 4.2% versus 0% (P = .511). Renal failure was absent in 82.6% of females versus 78.0% of males, mesenteric ischaemia occurred in 0% of females versus 1.2% of males (P = 1.000), and distal embolization in 4.2% versus 2.4%, respectively (P = 1.000). Mid-term follow-up showed excellent visceral vessel patency in both groups. Left renal artery patency was 100% in females versus 97.5% in males (P = 1.000); right renal artery patency was 100% versus 98.75%, respectively (P = 1.000); superior mesenteric artery patency was 100% in both groups (P = 1.000); and celiac trunk patency was 100% in females versus 98.3% in males (P = 1.000). The reintervention rates were similar between both groups (13.6% female vs 14.6% male, P = 1.000).

This study demonstrates that female patients undergoing FEVAR with the Anaconda stent graft achieved comparable mid-term outcomes to male patients. These results support the feasibility of FEVAR in women and highlight the need for sex-specific strategies to further improve outcomes.Clinical ImpactThis study demonstrates that female patients undergoing fenestrated endovascular aortic repair (FEVAR) with the Anaconda stent graft can achieve outcomes comparable to those of male patients, despite known anatomical challenges. Although the number of female patients was limited, these findings suggest that FEVAR is a feasible and safe treatment option for appropriately selected women. Given the underrepresentation of female patients in complex endovascular aortic repair, these results contribute to a better understanding of sex-specific outcomes and may encourage clinicians to consider FEVAR more frequently in women, as well as to pursue continued research focusing on sex-specific differences and long-term outcomes.