Staged hybrid TAAA repair, using a combination of proximal TEVAR with open distal repair, can be performed using established endovascular skills and technology coupled with traditional open aortic surgical techniques, with low surgical morbidity and mortality. In the midterm, staged hybrid TAAA repair was associated favorable survival, aortic remodeling, and freedom from reintervention.

comorbidity index in P2 (vs P1) in both cohorts (P < .001). Mortality trends are depicted in Fig 1 . There was a significant decline in IHM for all vascular patients during both time intervals, although no significant difference in the rate of decline was noted (Table ). There was no significant difference in IHM trends in P1 between MA and NMA; however, a significantly higher decrease in IHM was noted in MA compared with NMA in P2 (the annual odds ratio of IHM differed by 18%; P ¼ .010).Conclusions: Overall, a significant decrease in IHM for all vascular procedures was noted in the United States. The decline in postoperative IHM was significantly more rapid in the MA sample after 2006 compared with the NMA sample. This study suggests that better access to care in Massachusetts may be a cause of this decline in IHM.