Outcomes of endovascular aortic aneurysm repair in a long-term real-world cohort: Analysis from the first hybrid operating room in Türkiye

Background: This study aims to examine factors influencing mortality and reintervention among endovascular aortic aneurysm repair patients treated over nearly two decades in the first hybrid operating room of Türkiye. Methods: Between December 2006 and December 2020, a total of 372 patients (349 males, 23 females; mean age: 70.4±8.2 years; range, 45 to 89 years) who underwent endovascular aortic aneurysm repair were retrospectively analyzed. Independent predictors of 30-day, one-year, and five-year mortality rate were identified. The Kaplan-Meier analyses compared outcomes across surgical approaches and graft types. Results: Mortality rates were 6.5% at 30 days, 14.2% at one year, and 21.8% at five years. Multivariate analysis identified postoperative complications (hazard ratio [HR]=3.68, p=0.034), elevated creatinine (HR=1.58, p=0.004), prolonged intubation (HR=1.01, p<0.001), and increased blood transfusion volume (HR=1.17, p=0.003) as independent predictors of 30-day mortality. Advanced age emerged as a significant predictor of five-year mortality (HR=1.09, p<0.001). Elective procedures and bi-iliac grafts demonstrated significantly improved survival across all timeframes (p<0.001). Conclusion: This real-world analysis identifies several procedural and patient-related factors associated with mortality following endovascular aortic aneurysm repair. Postoperative care indicators consistently demonstrated stronger independent associations with mortality than anatomical or demographic factors, highlighting the importance of comprehensive perioperative care optimization in endovascular aortic aneurysm repair management.