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National trends and regional variation of open and endovascular repair of thoracic and thoracoabdominal aneurysms in contemporary practice.
Scali, Salvatore T; Goodney, Philip P; Walsh, Daniel B; Travis, Lori L; Nolan, Brian W; Goodman, David C; Lucas, F Lee; Stone, David H.
Afiliação
  • Scali ST; Section of Vascular Surgery, Shands Hospital-University of Florida, Gainesville, FL 32610-0128, USA. salvatore.scali@surgery.ufl.edu
J Vasc Surg ; 53(6): 1499-505, 2011 Jun.
Article em En | MEDLINE | ID: mdl-21609795
ABSTRACT

OBJECTIVES:

Successful surgical management of thoracic aortic aneurysms (TAA) and thoracoabdominal aortic aneurysms (TAAA) has historically relied upon open surgical repair (OSR). More recently, the advent and application of thoracic endovascular stent graft aneurysm repair (TEVAR) permutations have become increasingly performed in contemporary practice. To better determine the effect of TEVAR techniques on OSR, we examined national and regional trends in treatment use.

METHODS:

All Medicare patients from 1998 through 2007 undergoing isolated TAA and TAAA repair were analyzed using a clinically validated algorithm using diagnostic International Classification of Disease 9th revision (ICD-9; 441.1, 441.2, 441.6, 441.7, 441.9) codes and procedural (ICD-9 OSR 38.35, 38.45 and TEVAR 39.73, 39.79) codes. Differential rates of OSR and TEVAR were compared across census tract regions during the study interval.

RESULTS:

Total complex aortic repairs increased by 60%, from 10.8 to 17.8/100,000, between 1998 and 2007 (P < .001). A dramatic increase occurred in TEVAR (not performed in 1998, 5.8/100,000 in 2007) during the study period, but OSR rates remained stable during the same interval (10.7 to 12.0/100,000 in 2007, P = NS). There was substantial regional variation for both OSR and TEVAR. This regional variation was greater in OSR (range, 8.8-16.7/100,000) than in TEVAR (range, 4.5-6.9/100,000).

CONCLUSIONS:

Degenerative TAA and TAAA aneurysms are being repaired in the United States at an increasing rate. This reflects the rapid acceptance of TEVAR, which apparently supplements rather than supplants OSR. There appears to be greater regional variation in OSR compared with TEVAR. These data may have significant implications for those interested in the effect of new technologies on health care and cost containment.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Prótese Vascular / Stents / Aneurisma da Aorta Torácica / Implante de Prótese Vascular Limite: Humans País/Região como assunto: America do norte Idioma: En Ano de publicação: 2011 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Prótese Vascular / Stents / Aneurisma da Aorta Torácica / Implante de Prótese Vascular Limite: Humans País/Região como assunto: America do norte Idioma: En Ano de publicação: 2011 Tipo de documento: Article