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Objective: To describe outcomes after elective and non-elective fenestrated-branched endovascular aortic repair (FB-EVAR) for thoracoabdominal aortic aneurysms (TAAAs). Summary of Background Data: FB-EVAR has been increasingly utilized to treat TAAAs; however, outcomes after non-elective versus elective repair are not well described. Methods: Clinical data of consecutive patients undergoing FB-EVAR for TAAAs at 24 centers (2006-2021) were reviewed. Endpoints including early mortality and major adverse events (MAEs), all-cause mortality, and aortic-related mortality (ARM), were analyzed and compared in patients who had non-elective versus elective repair. Results: A total of 2,603 patients (69% males; mean age 72±10 y-old) underwent FB-EVAR for TAAAs. Elective repair was performed in 2,187 patients (84%) and non-elective repair in 416 patients (16%; 268 [64%] symptomatic, 148 [36%] ruptured). Non-elective FB-EVAR was associated with higher early mortality (17% vs. 5%, P<0.001) and rates of MAEs (34% vs. 20%, P<0.001). Median follow-up was 15 months (interquartile range, 7-37 mo). Survival and cumulative incidence of ARM at 3-years were both lower for non-elective versus elective patients (50±4% vs. 70±1% and 21±3% vs. 7±1%, P<0.001). On multivariable analysis, non-elective repair was associated with increased risk of all-cause mortality (hazard ratio [HR], 1.92; 95% confidence interval [CI], 1.50-2.44; P<0.001) and ARM (HR, 2.43; 95% CI, 1.63-3.62; P<0.001). Conclusions: Non-elective FB-EVAR of symptomatic or ruptured TAAAs is feasible, but carries higher incidence of early MAEs and increased all-cause mortality and ARM than elective repair. Long-term follow-up is warranted to justify the treatment.

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