Division of Vascular Surgery and Endovascular Therapy, Hospital of the University of Pennsylvania, Philadelphia, Pa.
Division of Vascular Surgery and Endovascular Therapy, Hospital of the University of Pennsylvania, Philadelphia, Pa.
J Vasc Surg. 2018 Jun;67(6):1649-1658. doi: 10.1016/j.jvs.2017.09.050. Epub 2018 Mar 2.
The advent of endovascular repair for both thoracic aortic aneurysm and type B dissection has transformed the management of these disease processes. This study was undertaken to better define, compare, and contrast the national trends in hospital admissions, invasive treatments, and inpatient mortality of patients with thoracic aortic aneurysm and type B dissection in the National Inpatient Sample.
The cohort was derived from International Classification of Diseases, Ninth Revision diagnosis codes for thoracic aortic dissection and thoracic aortic or thoracoabdominal aortic aneurysm. Patients receiving type A dissection or ascending aortic repair during their index admission were excluded using International Classification of Diseases, Ninth Revision procedure codes. A total of 155,187 patients were available for analysis from 2000 to 2012.
Admissions for thoracic aortic aneurysm outnumbered the admissions for type B dissection (69.8% vs 30.2%; P < .001), and the number of admissions for aneurysm grew more rapidly during this time (132% vs 63%; P < .001). Thoracic endovascular aortic repair (TEVAR) for aneurysm experienced an increase in 2005, concordant with Food and Drug Administration approval of TEVAR for thoracic aortic aneurysm indication, then superseded open repair for thoracic aortic aneurysm from 2006 onward. Despite this, the rate of thoracic aortic aneurysm repair has remained relatively stable over time. TEVAR for dissection increased in 2006, superseded open repair in 2010, and continues to account for 50.5% of all dissection repairs. 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. Despite the increased trends of utilization of TEVAR for both aneurysm and type B dissection, the overall in-hospital mortality rate among patients admitted for either disease state has decreased steadily over time (P < .001).
Whereas admissions for thoracic aortic aneurysm disease have increased over time, the rate of aneurysm repair has been stable, although TEVAR has supplanted a proportion of open repairs. In contrast, whereas admissions for type B dissection have experienced a more modest increase, there has been a disproportionate increase in type B dissection repair, largely due to increased use of TEVAR. These results show embracing of endovascular technology for dissection through expansion of indication. Despite the increase in rate of repair for type B dissection, inpatient mortality rate was reduced in both aneurysm and dissection patients, influenced by appropriate selection of patients for intervention.
胸主动脉瘤和 B 型夹层的血管内修复的出现改变了这些疾病的治疗方式。本研究旨在更好地定义、比较和对比国家住院患者的趋势，以及胸主动脉瘤和 B 型夹层患者的侵入性治疗和住院死亡率。
该队列来自国际疾病分类，第九版诊断代码为胸主动脉夹层和胸主动脉或胸腹主动脉瘤。使用国际疾病分类，第九版手术代码排除在指数入院期间接受 A 型夹层或升主动脉修复的患者。共有 155187 名患者可用于 2000 年至 2012 年的分析。
胸主动脉瘤的入院人数多于 B 型夹层（69.8%比 30.2%；P<.001），并且在此期间，动脉瘤的入院人数增长更快（132%比 63%；P<.001）。胸主动脉腔内修复术（TEVAR）用于动脉瘤的数量在 2005 年增加，与食品和药物管理局批准 TEVAR 用于胸主动脉瘤适应证一致，然后从 2006 年开始取代开放修复用于胸主动脉瘤。尽管如此，随着时间的推移，胸主动脉瘤修复的比率一直相对稳定。2006 年，夹层的 TEVAR 数量增加，2010 年取代了开放修复，并且继续占所有夹层修复的 50.5%。总体而言，B 型夹层修复的数量有所增加（P<.001），超过了 B 型夹层入院人数的增加。尽管胸主动脉瘤和 B 型夹层的 TEVAR 使用趋势增加，但无论哪种疾病状态入院的患者的总体住院死亡率都在稳步下降（P<.001）。
随着时间的推移，胸主动脉瘤疾病的入院人数增加，动脉瘤修复的比率保持稳定，尽管 TEVAR 已经取代了一部分开放修复。相比之下，B 型夹层的入院人数略有增加，但 B 型夹层的修复数量却不成比例地增加，主要是由于 TEVAR 的使用增加。这些结果表明，通过扩大适应证，血管内技术在夹层中得到了广泛应用。尽管 B 型夹层的修复率增加，但动脉瘤和夹层患者的住院死亡率均有所降低，这受到了对介入治疗患者的适当选择的影响。
