Increasing Incidence of Thoracic Aortic Aneurysm Repair in Germany in the Endovascular Era: Secondary Data Analysis of the Nationwide German DRG Microdata

Abstract

Eighty per cent of patients treated surgically for a dTAA receive endovascular therapy, with low peri-operative mortality in non-ruptured cases. Elective endovascular repair should be considered for individuals at a high risk of rupture who are fit for surgery. Open repair, increased age, and a high comorbidity score are associated with higher mortality.

Editor's Choice – Sex Specific Differences in the Management of Descending Thoracic Aortic Aneurysms: Systematic Review with Meta-Analysis

“…7,15e17 In addition, five further studies with inclusion potential (showing odds or hazard ratios for sex) were identified, of which one reported TEVAR data only, 18 and four reported both TEVAR and open repair data, 19e22 although none had published sex specific data. Therefore, the authors were contacted and three were able to provide further details, 18,19,22 allowing inclusion of these three studies, giving a total number of seven studies for the meta-analysis. However, the additional data received from the nationwide German study revealed that the minority population, who had been treated by open repair, had a much younger mean age, with wider standard deviation, than other studies, particularly for men, implying that many patients <55 years had been included.…”

“…However, the additional data received from the nationwide German study revealed that the minority population, who had been treated by open repair, had a much younger mean age, with wider standard deviation, than other studies, particularly for men, implying that many patients <55 years had been included. 19 Therefore, it must be assumed that this open repair cohort was not limited to degenerative aortic disease and included a variety of other aetiologies, including patients with a connective tissue disease. Therefore, only the TEVAR data from the German nationwide study were included in this review.…”

“…The quality score ranged from five to nine with the observational non-population based studies yielding the lowest quality scores, 16e18 while the four population based studies had scores closer to the maximum. 7,15,19,22 The characteristics of all the included studies are summarised in Table 2.…”

“…There were four population based studies: two from the USA covering different time periods, 7,15 one from the UK, 22 and one from Germany, 19 contributing a total of 2441 women and 4193 men. Other studies from the USA from a single centre and two multicentre clinical trials provided 317 women and 481 men.…”

Treatment of Thoracic and Thoraco-abdominal Aortic Pathology in the Endovascular Era

“…Published in the current edition of the European Journal of Vascular and Endovascular Surgery (EJVES), two studies document this radical change in TAA and TAAA repair in Germany, in the period from 2005 to 2014. 1,2 These studies follow previously published papers by the same group assessing the practice of abdominal aortic aneurysm (AAA) repair in Germany. 3 The authors analysed a national administrative dataset, based on the International Statistical Classification of Diseases and Related Health Problems 10th Edition (ICD-10).…”