Does TEVAR provide a financial benefit for management of descending thoracic aortic pathologies?
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Does TEVAR provide a financial benefit for management of descending thoracic aortic pathologies?. P Narayan, A Wong, I Davies, A J Bryan, P Wilde, G J Murphy. Background Management of descending aortic pathology is a complex and challenging area

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P narayan a wong i davies a j bryan p wilde g j murphy

Does TEVAR provide a financial benefit for management of descending thoracic aortic pathologies?

P Narayan, A Wong, I Davies, A J Bryan, P Wilde, G J Murphy


P narayan a wong i davies a j bryan p wilde g j murphy

Background descending thoracic aortic pathologies?

Management of descending aortic pathology is a complex and challenging area

Surgical management is indicated in specific situations

Endo-Vascular Surgical Repair [TEVAR] provides another important option

Aim

To assess early and mid term outcomes of TEVAR compared with surgical repair

To compare the financial implications of TEVAR and surgical management


Methods
Methods descending thoracic aortic pathologies?

  • Retrospective study

  • Time period: April 1996- February 2009

  • 85 procedures

    Surgical repair: 35

    TEVAR: 49

  • Data accessed from computerised database –PATS System

    and validated by case note reviews

  • Hospital costs calculated from NHS reference costs for staff time, consumables, transfusion and length of stay.


Statistical analysis
Statistical Analysis descending thoracic aortic pathologies?

  • Data tabulated as N(%) for categorical data and median (inter-quartile range) for continuous data

  • Continuous variables analysed with Mann Whitney U test

  • Categorical variables analysed with Fisher’s exact test or Chi-square

  • Kaplan-Meier estimates were used to compare re- intervention and survival


Trends in the management of descending thoracic aortic pathology
Trends in the Management of Descending descending thoracic aortic pathologies? Thoracic Aortic Pathology


Patient characteristics
Patient Characteristics descending thoracic aortic pathologies?


Procedural characteristics
Procedural Characteristics descending thoracic aortic pathologies?


In hospital clinical outcome
In Hospital Clinical Outcome descending thoracic aortic pathologies?


Hospitalisation costs of evar versus surgery
Hospitalisation Costs of EVAR versus Surgery descending thoracic aortic pathologies?


Mid term follow up
Mid-term Follow-up descending thoracic aortic pathologies?


Mid term outcomes of tevar and surgery for diseases of the descending thoracic aorta
Mid-term Outcomes of TEVAR and Surgery for Diseases of the Descending Thoracic Aorta

Re-intervention

Mortality

Log Rank p=0.002

Log Rank p=0.901

TEVAR

TEVAR

Surgery

Surgery


Conclusions
Conclusions Descending Thoracic Aorta

  • TEVAR is associated with superior short-term results

  • Mid term survival is similar to surgery

  • Re-intervention rate is significantly higher in TEVAR

  • Resource utilisation is similar in both groups for the primary procedure

  • Costs may prove to be higher in the TEVAR group with re-interventions