Thoracic endovascular aortic repair practice in 13 countries: A report from vascunet and the international consortium of vascular registries

Abstract

Objective: To assess practice patterns and short-term outcome after thoracic endovascular aortic repair (TEVAR), based on an international vascular registry collaboration. Summary Background Data: TEVAR has become the primary surgical treatment modality for descending aortic pathologies, and has expanded to new patient cohorts, including the elderly. Methods: Data on thoracic aortic aneurysms (TAA), type B aortic dis- sections (TBAD), and traumatic aortic injuries (TAI) treated with TEVAR from 2012 to 2016 were retrieved from registries and centers in 13 countries. Results: Nine-thousand five-hundred eighteen TEVAR for TAA (n = 4436), TBAD (n = 3976) and TAI (n = 1106) were included. The dis- tribution of TEVAR procedures per pathology varied, with TAA repair constituting from 40% of TEVARs in the US to 72% in the UK (P < 0.001). Mean intact TAA (iTAA) diameter varied from 59 (US) to 69 mm (Nancy, France) (P < 0.001), 25.3% of patients having a dia- meter of < 60 mm. Perioperative mortality after iTAA repair was 4.9%; combined mortality, stroke, paraplegia, and renal replacement therapy outcome was 12.8%. 18.6% of iTAA patients were ≥80 years old. Mortality was higher in this group (7.2%) than in patients < 80 (3.8%) (P < 0.001). After rTAA repair, perioperative mortality was 26.8%. Mortality was 9.7% after acute (within 14 days from onset of dissection) and 3.0% after chronic TBAD repair (P < 0.001). Mortality after TAI was 7.8%, and depended on injury severity (grade IV (free rupture) 20.9%). Conclusions: This registry collaboration provides a unique platform to evaluate cross-border patterns of use and outcomes of TEVAR. A common core dataset is proposed, to achieve harmonization of registry- based quality outcome measures for TEVAR.