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

Andrea Vacirca; Thomas Mesnard; Ying Huang; Bernardo C Mendes; Tomasz Jakimowicz; Darren B Schneider; Stéphan Haulon; Jonathan Sobocinski; Adam W Beck; Andres Schanzer; Mark A Farber; Carlos Timaran; Andrea Kahlberg; Tilo Kölbel; Warren J Gasper; Barend M E Mees; Mauro Gargiulo; Nuno V Dias; Anthony Lee Woongchae; Matthew P Sweet; Kevin Mani; Matthew Eagleton; Luis Mendes Pedro; Hence Verhagen; Kak Khee Yeung; Nikolaos Tsilimparis; Timothy Resch; Luca Bertoglio; Emília Ferreira; Manar Khashram; Titia Sulzer; Marina Dias-Neto; Emanuel R Tenorio; Lucas Ruiter Kanamori; Katarzyna Jama; Ezequiel Parodi; Vivian Gomes; Jesus Porras Colon; Roberto Chiesa; Giuseppe Panuccio; Geert Willem Schurink; Charlotte Lemmens; Enrico Gallitto; Gianluca Faggioli; Angelos Karelis; Anders Wanhainen; Mohammed Habib; Ryan Gouveia E Melo; Kaj Olav Kappe; Samira Elize Mariko van Knippenberg; Gustavo Silveira De Castro E Oderich; International Multicenter Aortic Research Group

doi:10.1016/j.jvs.2025.02.032

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

Andrea Vacirca, Thomas Mesnard, Ying Huang, Bernardo C Mendes, Tomasz Jakimowicz, Darren B Schneider, Stéphan Haulon, Jonathan Sobocinski, Adam W Beck, Andres Schanzer, Mark A Farber, Carlos Timaran, Andrea Kahlberg, Tilo Kölbel, Warren J Gasper, Barend M E Mees, Mauro Gargiulo, Nuno V Dias, Anthony Lee Woongchae, Matthew P SweetKevin Mani, Matthew Eagleton, Luis Mendes Pedro, Hence Verhagen, Kak Khee Yeung, Nikolaos Tsilimparis, Timothy Resch, Luca Bertoglio, Emília Ferreira, Manar Khashram, Titia Sulzer, Marina Dias-Neto, Emanuel R Tenorio, Lucas Ruiter Kanamori, Katarzyna Jama, Ezequiel Parodi, Vivian Gomes, Jesus Porras Colon, Roberto Chiesa, Giuseppe Panuccio, Geert Willem Schurink, Charlotte Lemmens, Enrico Gallitto, Gianluca Faggioli, Angelos Karelis, Anders Wanhainen, Mohammed Habib, Ryan Gouveia E Melo, Kaj Olav Kappe, Samira Elize Mariko van Knippenberg, Gustavo Silveira De Castro E Oderich^*, International Multicenter Aortic Research Group

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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 major adverse events (MAE) 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 3,634 patients (68% males; mean age 71±9 years-old) 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% (IQR, 18-33%) and 15% (IQR, 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 (OR 1.01, 95% 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-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.

Original language	English
Journal	Journal of Vascular Surgery
DOIs	https://doi.org/10.1016/j.jvs.2025.02.032
Publication status	E-pub ahead of print - 5 Mar 2025

Keywords

Thoracoabdominal aortic aneurysm
failure to rescue
fenestrated-branched endovascular aortic repair
in-hospital mortality
major adverse events

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10.1016/j.jvs.2025.02.032

Cite this

Vacirca, A., Mesnard, T., Huang, Y., Mendes, B. C., Jakimowicz, T., Schneider, D. B., Haulon, S., Sobocinski, J., Beck, A. W., Schanzer, A., Farber, M. A., Timaran, C., Kahlberg, A., Kölbel, T., Gasper, W. J., Mees, B. M. E., Gargiulo, M., Dias, N. V., Woongchae, A. L., ... International Multicenter Aortic Research Group (2025). Predictors of failure to rescue after fenestrated-branched endovascular aortic repair of thoracoabdominal aortic aneurysms. Journal of Vascular Surgery. Advance online publication. https://doi.org/10.1016/j.jvs.2025.02.032

@article{d4459e398f0f404d81183144e660b7c6,

title = "Predictors of failure to rescue after fenestrated-branched endovascular aortic repair of thoracoabdominal aortic aneurysms",

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 major adverse events (MAE) 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 3,634 patients (68% males; mean age 71±9 years-old) 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% (IQR, 18-33%) and 15% (IQR, 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 (OR 1.01, 95% 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-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 = "Thoracoabdominal aortic aneurysm, failure to rescue, fenestrated-branched endovascular aortic repair, in-hospital mortality, major adverse events",

author = "Andrea Vacirca and Thomas Mesnard and Ying Huang and Mendes, {Bernardo C} and Tomasz Jakimowicz and Schneider, {Darren B} and St{\'e}phan Haulon and Jonathan Sobocinski and Beck, {Adam W} and Andres Schanzer and Farber, {Mark A} and Carlos Timaran and Andrea Kahlberg and Tilo K{\"o}lbel and Gasper, {Warren J} and Mees, {Barend M E} and Mauro Gargiulo and Dias, {Nuno V} and Woongchae, {Anthony Lee} and Sweet, {Matthew P} and Kevin Mani and Matthew Eagleton and Pedro, {Luis Mendes} and Hence Verhagen and Yeung, {Kak Khee} and Nikolaos Tsilimparis and Timothy Resch and Luca Bertoglio and Em{\'i}lia Ferreira and Manar Khashram and Titia Sulzer and Marina Dias-Neto and Tenorio, {Emanuel R} and Kanamori, {Lucas Ruiter} and Katarzyna Jama and Ezequiel Parodi and Vivian Gomes and Colon, {Jesus Porras} and Roberto Chiesa and Giuseppe Panuccio and Schurink, {Geert Willem} and Charlotte Lemmens and Enrico Gallitto and Gianluca Faggioli and Angelos Karelis and Anders Wanhainen and Mohammed Habib and {Gouveia E Melo}, Ryan and Kappe, {Kaj Olav} and {Mariko van Knippenberg}, {Samira Elize} and {Silveira De Castro E Oderich}, Gustavo and {International Multicenter Aortic Research Group}",

year = "2025",

month = mar,

day = "5",

doi = "10.1016/j.jvs.2025.02.032",

language = "English",

journal = "Journal of Vascular Surgery",

issn = "0741-5214",

publisher = "Elsevier Inc.",

}

Vacirca, A, Mesnard, T, Huang, Y, Mendes, BC, Jakimowicz, T, Schneider, DB, Haulon, S, Sobocinski, J, Beck, AW, Schanzer, A, Farber, MA, Timaran, C, Kahlberg, A, Kölbel, T, Gasper, WJ, Mees, BME, Gargiulo, M, Dias, NV, Woongchae, AL, Sweet, MP, Mani, K, Eagleton, M, Pedro, LM, Verhagen, H, Yeung, KK, Tsilimparis, N, Resch, T, Bertoglio, L, Ferreira, E, Khashram, M, Sulzer, T, Dias-Neto, M, Tenorio, ER, Kanamori, LR, Jama, K, Parodi, E, Gomes, V, Colon, JP, Chiesa, R, Panuccio, G, Schurink, GW , Lemmens, C, Gallitto, E, Faggioli, G, Karelis, A, Wanhainen, A, Habib, M, Gouveia E Melo, R, Kappe, KO, Mariko van Knippenberg, SE, Silveira De Castro E Oderich, G & International Multicenter Aortic Research Group 2025, 'Predictors of failure to rescue after fenestrated-branched endovascular aortic repair of thoracoabdominal aortic aneurysms', Journal of Vascular Surgery. https://doi.org/10.1016/j.jvs.2025.02.032

TY - JOUR

T1 - Predictors of failure to rescue after fenestrated-branched endovascular aortic repair of thoracoabdominal aortic aneurysms

AU - Vacirca, Andrea

AU - Mesnard, Thomas

AU - Huang, Ying

AU - Mendes, Bernardo C

AU - Jakimowicz, Tomasz

AU - Schneider, Darren B

AU - Haulon, Stéphan

AU - Sobocinski, Jonathan

AU - Beck, Adam W

AU - Schanzer, Andres

AU - Farber, Mark A

AU - Timaran, Carlos

AU - Kahlberg, Andrea

AU - Kölbel, Tilo

AU - Gasper, Warren J

AU - Mees, Barend M E

AU - Gargiulo, Mauro

AU - Dias, Nuno V

AU - Woongchae, Anthony Lee

AU - Sweet, Matthew P

AU - Mani, Kevin

AU - Eagleton, Matthew

AU - Pedro, Luis Mendes

AU - Verhagen, Hence

AU - Yeung, Kak Khee

AU - Tsilimparis, Nikolaos

AU - Resch, Timothy

AU - Bertoglio, Luca

AU - Ferreira, Emília

AU - Khashram, Manar

AU - Sulzer, Titia

AU - Dias-Neto, Marina

AU - Tenorio, Emanuel R

AU - Kanamori, Lucas Ruiter

AU - Jama, Katarzyna

AU - Parodi, Ezequiel

AU - Gomes, Vivian

AU - Colon, Jesus Porras

AU - Chiesa, Roberto

AU - Panuccio, Giuseppe

AU - Schurink, Geert Willem

AU - Lemmens, Charlotte

AU - Gallitto, Enrico

AU - Faggioli, Gianluca

AU - Karelis, Angelos

AU - Wanhainen, Anders

AU - Habib, Mohammed

AU - Gouveia E Melo, Ryan

AU - Kappe, Kaj Olav

AU - Mariko van Knippenberg, Samira Elize

AU - Silveira De Castro E Oderich, Gustavo

AU - International Multicenter Aortic Research Group

PY - 2025/3/5

Y1 - 2025/3/5

N2 - 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 major adverse events (MAE) 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 3,634 patients (68% males; mean age 71±9 years-old) 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% (IQR, 18-33%) and 15% (IQR, 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 (OR 1.01, 95% 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-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.

AB - 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 major adverse events (MAE) 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 3,634 patients (68% males; mean age 71±9 years-old) 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% (IQR, 18-33%) and 15% (IQR, 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 (OR 1.01, 95% 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-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.

KW - Thoracoabdominal aortic aneurysm

KW - failure to rescue

KW - fenestrated-branched endovascular aortic repair

KW - in-hospital mortality

KW - major adverse events

U2 - 10.1016/j.jvs.2025.02.032

DO - 10.1016/j.jvs.2025.02.032

M3 - Article

SN - 0741-5214

JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

ER -

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

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