Changes in treatment patterns of thoracoabdominal aortic aneurysms in the United StatesCentral MessagePerspective
Joy Mohnot, BS,
Yunda (George) Wang, MS,
Kanhua Yin, MD, MPH,
Mahmoud B. Malas, MD,
Niloo M. Edwards, MD,
Nikola Dobrilovic, MD,
Yong Zhan, MD
Affiliations
Joy Mohnot, BS
Division of Cardiothoracic Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Mass
Yunda (George) Wang, MS
Division of Cardiothoracic Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Mass
Kanhua Yin, MD, MPH
Department of Surgery, University of Missouri - Kansas City School of Medicine, Kansas City, Mo
Mahmoud B. Malas, MD
Vascular and Endovascular Surgery, University of California San Diego, San Diego, Calif
Niloo M. Edwards, MD
Division of Cardiothoracic Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Mass
Nikola Dobrilovic, MD
Division of Cardiothoracic Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Mass; Division of Cardiac Surgery, NorthShore University HealthSystem, Chicago, Ill
Yong Zhan, MD
Division of Cardiac Surgery, CardioVascular Center, Tufts Medical Center, Boston, Mass; Address for reprints: Yong Zhan, MD, CardioVascular Center, Tufts Medical Center, 800 Washington St, Boston, MA 02111.
Background: The introduction of endovascular repair provides an alternative to traditional open repair of thoracoabdominal aortic aneurysms (TAAA). Its utility is not well defined, however. Using a national database, we studied the treatment patterns and outcomes of TAAA to gain insight into its contemporary surgical practice in the United States. Methods: Records of TAAA patients who received endovascular and open repair were retrieved from the 2002 to 2018 National Inpatient Sample database. Each cohort was stratified into 4 age groups: ≤50, 51 to 60, 61 to 70, and >70 years. Patient characteristics and in-hospital outcomes were compared between the 2 repair modalities. Temporal trends were investigated. Results: Endovascular repair use increased steadily, whereas open repair volume remained stable until 2012, before declining by 50% by 2018. This appears to be associated with a declining number of open repairs in patients age >60 years. Patients who underwent endovascular repair were older and had a higher Charlson Comorbidity Index (mean, 2.8 ± 1.7 vs 2.5 ± 1.5; P 60 years but not for patients age ≤60 years. Conclusions: There has been a shift in the treatment of TAAA in the United States from open repair–dominant to endovascular repair–dominant. It has increased surgical access for older and more comorbid patients and has led to a decline in the use of open repair while lowering in-hospital mortality.
