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Multicenter Study
. 2025 Jul;82(1):32-42.e3.
doi: 10.1016/j.jvs.2025.02.032. Epub 2025 Mar 5.

Predictors of failure to rescue after fenestrated-branched endovascular aortic repair of thoracoabdominal aortic aneurysms

Andrea Vacirca  1 , Thomas Mesnard  2 , Ying Huang  3 , Bernardo C Mendes  4 , Tomasz Jakimowicz  5 , Darren B Schneider  6 , Stéphan Haulon  7 , Jonathan Sobocinski  8 , Adam W Beck  9 , Andres Schanzer  10 , Mark A Farber  11 , Carlos Timaran  12 , Andrea Kahlberg  13 , Tilo Kölbel  14 , Warren J Gasper  15 , Barend M E Mees  16 , Mauro Gargiulo  17 , Nuno V Dias  18 , Anthony Lee Woongchae  19 , Matthew P Sweet  20 , Kevin Mani  21 , Matthew Eagleton  22 , Luis Mendes Pedro  23 , Hence Verhagen  24 , Kak Khee Yeung  25 , Nikolaos Tsilimparis  26 , Timothy Resch  27 , Luca Bertoglio  28 , Emília Ferreira  29 , Manar Khashram  30 , Titia Sulzer  31 , Marina Dias-Neto  32 , Emanuel R Tenorio  32 , Lucas Ruiter Kanamori  3 , Katarzyna Jama  5 , Ezequiel Parodi  11 , Vivian Gomes  11 , Jesus Porras Colon  12 , Roberto Chiesa  13 , Giuseppe Panuccio  14 , Geert Willem Schurink  16 , Charlotte Lemmens  16 , Enrico Gallitto  17 , Gianluca Faggioli  17 , Angelos Karelis  18 , Anders Wanhainen  21 , Mohammed Habib  21 , Ryan Gouveia E Melo  23 , Kaj Olav Kappe  25 , Samira Elize Mariko van Knippenberg  25 , BichLan Tran  25 , Sean Crawford  7 , Marco Panagrosso  27 , Andrea Melloni  28 , Stefano Bonardelli  28 , Rita Garcia  29 , Tiago Ribeiro  29 , Sinead Gormley  30 , Steven Maximus  3 , Gustavo S Oderich  33 ; International Multicenter Aortic Research Group
Affiliations
Multicenter Study

Predictors of failure to rescue after fenestrated-branched endovascular aortic repair of thoracoabdominal aortic aneurysms

Andrea Vacirca et al. J Vasc Surg. 2025 Jul.

Abstract

Objective: Failure to rescue (FTR), defined as mortality due to failure in responding to in-hospital complications, is an important quality indicator. This study aimed to assess incidence and predictors for FTR among centers performing fenestrated-branched endovascular aortic repair (FB-EVAR) of thoracoabdominal aortic aneurysms (TAAA).

Methods: Consecutive patients treated by FB-EVAR for TAAAs between 2005 and 2022 in 27 centers of the International Multicenter Aortic Research Group were analyzed. Data were obtained from the United States Aortic Research Consortium, which contains prospectively collected data of physician-sponsored investigational device exemption studies from 10 centers, and retrospective center data from Europe and New Zealand. FTR was defined as in-hospital mortality following ≥1 major adverse event (MAE). Primary endpoints were rates of postoperative MAEs, including major cardiac (myocardial infarction, cardiovascular collapse, acute congestive heart failure) and respiratory events, major stroke, paraplegia, acute kidney injury (AKI), and bowel ischemia requiring surgical resection or escalation of care and FTR. Multivariate analysis was performed to identify predictors for MAEs and FTR.

Results: There were 3634 patients (68% males; mean age, 71 ± 9 years) treated by FB-EVAR for TAAAs. Technical success was achieved in 94%, with 5% in-hospital mortality. Median incidences of MAEs and FTR were 27% (interquartile range, 18%-33%) and 15% (interquartile range, 6%-21%). There was a significantly (33% vs 20%; P < .001) higher rate of MAEs among centers with annual volume below the median (11 cases). Independent predictors for MAEs included age (odds ratio [OR], 1.01; 95% confidence interval [CI], 1.00-1.02; P = .02), chronic kidney disease (OR, 1.88; 95% CI, 1.54-2.29; P ≤ .001), ASA class ≥3 (OR, 1.70; 95% CI, 1.21-2.38; P = .002), previous aortic repair (OR, 0.74; 95% CI, 0.60-0.91; P = .004), symptomatic/ruptured (OR, 1.76; 95% CI, 1.36-2.28; P < .001), extent I to III TAAA (OR, 2.28; 95% CI, 1.75-2.97; P < .001), and lower annual volume (<11 cases/year: OR, 1.83; 95% CI, 1.40-2.38; P < .001). Symptomatic/ruptured TAAA was an independent predictor for FTR (OR, 2.99; 95% CI, 1.62-5.52; P < .001).

Conclusions: FB-EVAR was performed with low in-hospital mortality. Lower volume centers had higher rates of MAEs, but center volume was not related to FTR. Symptomatic/ruptured TAAAs were independently predictive of FTR.

Keywords: Failure to rescue; Fenestrated-branched endovascular aortic repair; In-hospital mortality; Major adverse events; Thoracoabdominal aortic aneurysm.

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Conflict of interest statement

Disclosures B.C.M. reports consulting and research funding from Cook Medical and W. L. Gore; and scientific advisory board of Cook Medical and Medtronic. D.B.S. reports consulting, research grants, and/or advisory boards for Cook Medical, Medtronic, Philips, WL Gore, and ViTAA. S.H. reports consulting and intellectual property expertise for Cook Medical, GE Healthcare, and Bentley. J.S. reports consulting, research grants and/or advisory boards for Cook Medical, WL Gore, and GE Healthcare. A.B. reports consulting, research grants and/or advisory boards for Artivion, Cook Medical, Medtronic, Philips, WL Gore, and Terumo. A.S. reports consulting, research grants and/or advisory boards for Cook Medical, Philips Imaging, and Artivion. M.F. reports consulting, research grants, and/or advisory boards for Cook Medical, WL Gore, ViTAA, Centerline, and Getinge. C.T. reports consulting, research grants, and/or advisory boards for Cook Medical and WL Gore. A.K. reports consulting, research grants and/or advisory board for Cook Medical, Medtronic, WL Gore, Terumo, and Getinge. T.K. reports consulting, royalties, research grants, and/or advisory boards for Cook Medical, Philips, Terumo Aortic, and Getinge. B.M. reports consulting, research grants, and/or advisory boards for Cook Medical, WL Gore, Philips, and Bentley. M.G. reports proctoring fees for Cook Medical. N.V.D. reports consulting, research grants, and/or advisory boards for Cook Medical, Medtronic, WL Gore, and Siemens Heathneers. K.M. reports consulting and institutional grant for Cook Medical. L.M.P. reports speaking and proctoring fees for Cook Medical; and speaking fees for WL Gore and Terumo aortic. K.K.Y. reports consulting fees and research grants from WL Gore, Medtronic, Artivion; consulting fees from Terumo Aortic; and research grants from the Dutch Heart Foundation and Horizon Europe, European Commission. N.T. reports consulting and research grants from Cook Medical, Medtronic, Bentley, Siemens, iVascular, and Terumo Aortic. T.R. reports consulting grants for Cook Medical, WL Gore, Philips, and Artivion. L.B. reports consulting, research grants and/or advisory boards for Cook Medical. M.K. reports consulting, research grants, and/or advisory boards for Medtronic and WL Gore. G.W.S. reports consulting, research grants, and/or advisory boards for Cook Medical and Philips. E.G. reports proctoring fees for Cook Medical. A.W. reports institutional educational grant from Cook Medical. R.G.M. reports speaking fees for Cook Medical. K.K. reports research grant from Medtronic. G.S.O. reports consulting, research grants and/or advisory boards for Cook Medical, WL Gore, GE Healthcare, and Centerline.

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