Change in the Treatment Pattern of Open vs Endovascular Repair of Thoracoabdominal Aortic Aneurysm in the US: A Population-Level Analysis

Abstract

INTRODUCTION: Operative treatment of thoracoabdominal aortic aneurysm (TAAA) remains challenging. Endovascular repair provides an alternative to traditional open repair. Using a national healthcare database, we aimed to understand the changes in treatment patterns of TAAA during the last 2 decades. METHODS: TAAA patients who received operative treatment were retrieved from the 2002 to 2018 National Inpatient Sample database using ICD codes. The cohort was divided into endovascular and open repair groups. Patient characteristics and in-hospital outcomes were compared between the 2. Trends over time were investigated. RESULTS: We identified a weighted total of 15,228 open and 12,341 endovascular repair cases. Endovascular repair steadily increased from 48 procedures in 2002 to 1,270 in 2018. Open repair was stable until 2014 but declined 50% by 2018 (Figure). Patients who underwent endovascular repair were older (72.1 ± 10.0 vs 67.1 ± 11.4 years, p < 0.001) and had a higher Charlson Comorbidity Index (2.8 ± 1.7 vs 2.5 ± 1.5, p < 0.001). They also had lower in-hospital mortality (8.8% vs 17.1%, p < 0.001), shorter length of stay (10.1 ± 12.2 vs 17.0 ± 17.4 days, p < 0.001), and fewer complications (cardiac: 8.4% vs 18.3%, p < 0.001; respiratory: 21.2% vs 45.4%, p < 0.001). Conclusion: The treatment pattern of TAAA in the US has shifted from open to endovascular repair. With a relatively low morbidity and mortality, endovascular repair appears to increase patient access to operative treatment of TAAA—especially in older and/or high-risk patients.Figure