10-Year Nationwide Experience in Management with Thoraco-Abdominal Aortic Aneurysms – Hospital Incidence, Treatment and Outcome of 885 Patients Treated in Switzerland

Abstract

Abstract Background Thoraco-abdominal aortic aneurysm (TAAA) repair remains a challenging disease pattern. The evolution of fenestrated and branched endografts (f/bEVAR) has provided a less invasive method of treating these aneurysms compared to open TAAA repair (OR). Aims To analyse hospital incidence and in-hospital mortality of patients treated for TAAA in Switzerland. Methods Secondary data analysis of case-related hospital discharge data of the Swiss Federal Statistical Office for the years 2009-2018. Standardised annual incidences rates were calculated using the European standard population 2013. In-hospital all-cause mortality rates were calculated as raw values and standardised for age, sex, and the van Walraven comorbidity score. Results A total of 885 cases were included in this study (16.8% ruptured (rTAAA), 83.2% non-ruptured (nrTAAA)), of which 69.3% were male. Overall hospital incidence rates for nrTAAA were 0.42 in 100,000 women and 0.9 in 100,000 men in 2009 and doubled for both sexes in 2018. For rTAAA, the hospital incidence rate ranged from 0.00 to 0.12 in 100 000 women and 0.02 to 0.18 in 100,000 men, with no trend over the years. 39.5% of patients with TAAA were treated with OR, 44.2% were treated with f/bEVAR, and 9.8% with hybrid repair with no difference in outcome for nrTAAA. All-cause mortality was 55% in rTAAA and 7.1% in nrTAAA. Mortality was lower in rTAAA, when f/bEVAR or hybrid procedures were used. An increased age, a ruptured aneurysm and higher comorbidity strongly correlated with increased in hospital mortality. Conclusions Hospital incidence for nrTAAA doubled over the 10-year time period in Switzerland. 44.2% of all TAAA were treated with f/bEVAR with an increasing frequency over the years. However, mortality remained largely unchanged for both, rTAAA and nrTAAA. Increased age, a ruptured aneurysm and higher comorbidity are associated with worse outcome.