Trends in repair of intact and ruptured descending thoracic aortic aneurysms in the United States: A population-based analysis

Background: To evaluate trends and outcomes of descending thoracic aortic aneurysm (DTAA) repair in the United States. Methods: Adults undergoing DTAA repair between 1998 and 2008 were identified in the Nationwide Inpatient Sample. To limit confounding, patients with connective tissue disorders, aortic dissection, or thoracoabdominal aneurysms were excluded. Stratification was based on intact versus ruptured DTAA and open versus endovascular approach. Standardized annual rates of repair were calculated based on US Census Bureau population estimates. Logistic regression analysis incorporating multiple patient, operative, and hospital variables was used for risk adjustment. Results: A total of 20,568 DTAA patients (intact, 17,780; ruptured, 2788) underwent repair (open, 15,265; endovascular, 5303). Patients undergoing repair in the more recent era had higher comorbidity burdens than those undergoing repair in the earlier era. Despite this, annual rates of repair for both intact and ruptured DTAAs increased significantly during the study period (intact, 2.2-10.6 per 1 million; ruptured, 0.8-1.3 per 1 million; P < .05), primarily because of increases in rates of endovascular repair in recent years. Operative mortality decreased from 10.3% to 3.1% for repairs of intact DTAAs (P < .001) and from 52.6% to 23.4% for ruptured DTAAs (P = .002). Endovascular repair was associated with reduced risk-adjusted mortality for both intact (odds ratio, 0.31; P < .001) and ruptured (odds ratio, 0.41; P = .001) DTAAs. Conclusions: Although patients undergoing DTAA repair in the modern era have a higher comorbidity burden, rates of repair have increased and operative mortality has decreased, in part because of the increasing adoption of endovascular approaches.