Incidence of Descending Aortic Pathology and Evaluation of the Impact of Thoracic Endovascular Aortic Repair: A Population-based Study in England and Wales from 1999 to 2010

von Allmen RS, Anjum A, Powell JT, et al (Imperial College, London, UK) Eur J Vasc Endovasc Surg 45:154-159, 2013^§

Abstract

Objectives

To investigate population trends in thoracic aortic disease (dissections and aneurysms) in England and Wales, with focus on the impact of thoracic endovascular aortic repair on procedure numbers and age at repair.

Materials and Methods

Routine hospital statistics of England and Wales provided admission, procedure and mortality data from 1999 to 2010. All data were age-standardised, reported per 100,000 population, by age bands (>50 years or 50–74 years versus 75+ years) and gender. Only patients 50+ years were included, to focus on degenerative disease.

Results

Between 1999 and 2010 hospital admissions for total (ascending and descending) have risen steadily for thoracic aortic dissection (TAD) from 7.2 to 8.8 and thoracic aortic aneurysm (TAA) from 4.4 to 9.0, principally attributable to increased admissions in those 75+ years. Total mortality declined steadily over the same period, for TAD from 4.4 to 3.2 and for TAA from 10.4 to 7.5. Procedure rates have risen sharply, driven by the implementation of TEVAR from 2006, for type B dissection from 0.06 to 0.53 and for descending TAA from 0.76 to 1.89. All figures are per 100,000 population with P < 0.005.

Conclusion

Improvements in case ascertainment may have contributed to the increase in hospital admissions. The increased application of TEVAR, particularly for dissections, is mainly in those above 75 years and has not yet translated into an accelerated survival benefit (Figs 4 and 5).

Figure 4 Repairs for descending thoracic aortic aneurysm in England and Wales 1999–2010, by age. TAA open repairs (solid grey bars) and TEVARs (solid black bars); 50–74 years on the left hand side and 75+ years on the right hand side. Data were standardised by age group for procedural codes; L18.2, L19.2, L20.2, L21.2 (open repair), L27.3, L28.3 (TEVAR). (Reprinted from European Journal of Vascular and Endovascular Surgery. von Allmen RS, Anjum A, Powell JT. Incidence of descending aortic pathology and evaluation of the impact of thoracic endovascular aortic repair: a population-based study in england and wales from 1999 to 2010. Eur J Vasc Endovasc Surg. 2013;45:154-159, Copyright 2013, with permission from European Society for Vascular Surgery.)

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