Division of Vascular and Endovascular Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA.
Division of Vascular and Endovascular Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA.
J Am Coll Surg. 2021 Jan;232(1):46-53.e2. doi: 10.1016/j.jamcollsurg.2020.09.011. Epub 2020 Oct 3.
Thoracic endovascular aortic repair (TEVAR) is indicated for treatment of aneurysms, dissections, and traumatic injury. We describe mid-term mortality and reintervention rates in Medicare beneficiaries undergoing TEVAR.
Patients who underwent TEVAR between 2006 and 2014 were identified by CPT codes in a 20% Medicare sample. Indication for aortic repair (aneurysm, dissection, trauma) was ascertained via ICD-9 codes. Follow-up was evaluated until 2015. Kaplan-Meier survival analysis and Cox regression were used to compare mortality, with reintervention and mortality rates expressed as a composite outcome in a hazard ratio with 95% confidence interval (hazard ratio [HR] 95% CI).
There were 3,095 patients who underwent TEVAR during the study period: 1,465 (47%) for aneurysm, 1,448 (47%) for dissection, and 182 (5.9%) for trauma. Mean patient age was 74.4 years, and 44.5% were female. Median follow-up was 2.7 years. The overall 30-day, 1-year, and 5-year, and 8-year survival rates were 93%, 78%, 49%, and 33%, respectively. Thirty-day mortality was highest in traumatic indications, but overall mortality was highest in patients undergoing TEVAR for aneurysm. Freedom from combined reintervention and mortality at 30 days, 1 year, 5 years, and 8 years was 89%, 73%, 43%, and 29%, respectively. Reintervention was highest in patients undergoing TEVAR for dissection (12.8%), followed by aneurysm (10.0%) and trauma (5.5%). Advanced age (HR 1.03 per year, 95% CI 1.02-1.03), congestive heart failure (CHF) (HR 1.48, 95% CI 1.33-1.65), dementia (HR 1.40, 95% CI 1.14-1.28), and rupture (HR 1.38, 95% CI 1.24-1.54) were associated with mortality.
Midterm survival is lower in patients who undergo TEVAR for dissection and aneurysm compared with trauma. Aneurysmal disease, advanced age, CHF, dementia, and aortic rupture are associated with mortality and reintervention in TEVAR.
胸主动脉腔内修复术（TEVAR）适用于治疗动脉瘤、夹层和创伤性损伤。我们描述了接受 TEVAR 治疗的 Medicare 受益人的中期死亡率和再干预率。
通过 Medicare 20%样本中的 CPT 代码确定 2006 年至 2014 年间接受 TEVAR 的患者。通过 ICD-9 代码确定主动脉修复的适应证（动脉瘤、夹层、创伤）。随访评估至 2015 年。使用 Kaplan-Meier 生存分析和 Cox 回归比较死亡率，再干预和死亡率表示为风险比（95%置信区间 [HR 95%CI]）的复合结局。
研究期间共有 3095 例患者接受 TEVAR 治疗：1465 例（47%）为动脉瘤，1448 例（47%）为夹层，182 例（5.9%）为创伤。患者平均年龄为 74.4 岁，44.5%为女性。中位随访时间为 2.7 年。总体 30 天、1 年、5 年和 8 年生存率分别为 93%、78%、49%和 33%。30 天死亡率在创伤性适应证中最高，但总体死亡率在接受 TEVAR 治疗的动脉瘤患者中最高。30 天、1 年、5 年和 8 年无联合再干预和死亡率分别为 89%、73%、43%和 29%。再干预率在接受 TEVAR 治疗的夹层患者中最高（12.8%），其次是动脉瘤（10.0%）和创伤（5.5%）。高龄（每年增加 1.03，95%CI 1.02-1.03）、充血性心力衰竭（CHF）（HR 1.48，95%CI 1.33-1.65）、痴呆（HR 1.40，95%CI 1.14-1.28）和破裂（HR 1.38，95%CI 1.24-1.54）与死亡率相关。
与创伤相比，接受 TEVAR 治疗的夹层和动脉瘤患者的中期生存率较低。动脉瘤性疾病、高龄、CHF、痴呆和主动脉破裂与 TEVAR 后的死亡率和再干预相关。
