A new study examined national trends in admissions, invasive treatments, and inpatient mortality of patients with thoracic aortic aneurysm and type B dissection. The study found that admissions for thoracic aortic aneurysm disease have increased over time but that the rate of aneurysm repair has been stable, with thoracic endovascular aortic repair (TEVAR) taking the place of some formerly open repairs. However, although admissions for type B dissection modestly increased, type B dissection repair has disproportionately increased, mostly as a result of increased use of TEVAR.
The study data were from the International Classification of Diseases, Ninth Revision diagnosis codes for thoracic aortic dissection and thoracic aortic or thoracoabdominal aortic aneurysm. There were 155,187 patients included in the analysis from 2000 to 2012. Patients were excluded using International Classification of Diseases, Ninth Revision procedure codes
if they received type A dissection or ascending aortic repair during their index admission.
The analysis found that 69.8% of admissions were for thoracic aortic aneurysm versus 30.2% for type B dissection. Additionally, the number of admissions for aneurysm grew more rapidly during this time
TEVAR was approved by the FDA for the thoracic aortic aneurysm indication in 2005, and the procedure superseded open repair for thoracic aortic aneurysm from 2006 onward. Nonetheless, over time, the rate of thoracic aortic aneurysm repair has stayed relatively stable, the authors noted.
In 2006, TEVAR for dissection increased, before surpassing open repair in 2010. TEVAR “continues to account for 50.5% of all dissection repairs,” the authors said. “Overall, the number of type B dissection repairs has increased (P < .001), over and above the increase in number of admissions for type B dissection.”
The overall in-hospital mortality rate among patients admitted for either disease state has declined over time even though TEVAR has been increasingly used for both aneurysm and type B dissection. The authors attribute this decrease to appropriate selection of patients for intervention.
“These results show embracing of endovascular technology for dissection through expansion of indication,” they concluded.
Wang GJ, Jackson BM, Foley PJ, et al. National trends in admissions, repair, and mortality for thoracic aortic aneurysm and type B dissection in the National Inpatient Sample. J Vasc Surg. 2018;67(6):1649-1658.