1. This retrospective cohort survey examining thoracic endovascular aortic repair (TEVAR) versus aesculapian therapy for uncomplicated benignant B aortic dissection recovered akin mortality and hospitalization rates betwixt attraction groups.
2. Approximately 16% of the survey colonisation received TEVAR; TEVAR receipt was importantly associated with younger age, the South region, hypertension, peripheral vascular disease, and the deficiency of congestive bosom failure.
Evidence Rating Level: 2 (Good)
Study Rundown: Type B aortic dissection (TBAD) is simply a uncommon but perchance fatal pathology. Thoracic endovascular aortic repair (TEVAR) is the attraction for analyzable TBAD; however, its relation successful treating uncomplicated TBAD (uTBAD) remains unclear, fixed that aesculapian therapy whitethorn beryllium sufficient. This retrospective cohort survey assessed patterns of TEVAR usage and examined outcomes betwixt TEVAR and aesculapian therapy for acute uTBAD. Patients 65 years and older with admittance for acute uTBAD betwixt 2011 and 2018 were included utilizing the Centers for Medicare and Medicaid Services Limited Data Set. The superior vulnerability was archetypal TEVAR, which was defined arsenic receiving the process wrong 30 days of admission. The superior result was all-cause mortality. Secondary outcomes included aorta-related hospitalizations, aortic interventions, and cardiovascular hospitalizations. Among the 7105 patients included successful the study, 1140 (16%) received TEVAR. Receipt of TEVAR was importantly associated with property (each further twelvemonth older reduced risk) and portion (South associated with greater hazard of TEVAR compared to Midwest and Northeast). Additionally, hypertension and peripheral vascular illness were associated with greater likelihood of TEVAR receipt. In the weighted analysis, receiving TEVAR was not importantly associated with reduced all-cause mortality astatine 1-year (HR: 1.05 [95% CI: 0.89-1.24]), 2-years (HR: 1.05 [95% CI: 0.99-1.14]), oregon 5-years (HR: 0.95 [95% CI: 0.85-1.06]) compared to aesculapian therapy. Aorta-related hospitalization, aortic intervention, and cardiovascular involution rates were besides akin betwixt those who received TEVAR and those who received aesculapian therapy. Overall, this retrospective cohort survey demonstrated that little than one-quarter of uTBAD patients received TEVAR and that TEVAR patterns appeared to beryllium influenced by property and location. Additionally, mortality and hospitalization rates were akin betwixt patients who received TEVAR and those who received aesculapian therapy. However, this survey was constricted by lone including patients with fee-for-service coverage; therefore, the results whitethorn not use to the full uTBAD population.
Click to work the survey successful JAMA Cardiology
Click to work an accompanying editorial successful JAMA Cardiology
Relevant Reading: Randomized examination of strategies for benignant B aortic dissection: The INSTEAD trial
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