Readmissions after thoracic endovascular aortic repair

Kalesan, Bindu; Cheng, Thomas W.; Farber, Alik; Zuo, Yi; Kalish, Jeffrey; Jones, Douglas W.; Siracuse, Jeffrey J.

doi:10.1016/j.jvs.2017.12.035

Cited by 15 publications

(9 citation statements)

References 25 publications

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“…In the present series, all but one complication was detected during hospitalisation, and only one male patient required readmission for surgical repair of a pseudoaneurysm. This outcome may be supported by a recent analysis by Kalesan et al, 30 which showed that a large proportion of patients treated by TEVAR were readmitted most commonly for heart related reasons at 30 days and aorta related reasons at 90 and 180 days. These findings are important to reinforce the concept that, especially for women, access related complications are related to the intrinsic characteristics of the vessels rather than the procedure or the device itself.…”

Section: Discussionmentioning

confidence: 62%

Gender Related Access Complications After TEVAR: Analysis from the Retrospective Multicentre Cohort GORE® GREAT Registry Study

Lomazzi

Mascoli

Beaufort

et al. 2020

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDSThis registry based multicentre study analysed the prevalence of access related complications after thoracic endovascular aortic repair (TEVAR) using standard thoracic endografts. The study suggests that access related complications are more frequent in women and that they are not dependent on clinical setting, underlying aortic pathology, or device sizing.Objective: The Global Registry for Endovascular Aortic Treatment (GREAT), a retrospective sponsored registry, was queried to determine the incidence and identify potential predictors of access related complications after TEVAR. Methods: This is a multicentre, observational cohort study. For the current study, all patients were treated only with the Conformable GORE Ò TAG Ò Thoracic Endoprosthesis and GORE Ò TAG Ò Thoracic Endoprosthesis devices for any kind of thoracic aortic disease. All serious adverse events within 30 days of the procedure were documented by sites. The following were considered access related complications: surgical site infection, pseudoaneurysm, avulsion, dissection, arterial bleeding, access vessel thrombosis/occlusion, seroma, and lymphocoele. Results: A total of 887 patients was analysed: most of the cases had an operative indication for TEVAR of degenerative atherosclerotic aneurysm (n ¼ 414, 46.7%) and type B dissection (n ¼ 270, 30.4% either complicated or uncomplicated). Two hundred and ninety-five patients (33.3%) were female. The overall access related complication rate was 2.8% (n ¼ 25): 4.7% (n ¼ 14) in women and 1.8% (n ¼ 11) in men (p ¼ .013). After adjustment for age, urgency, device diameter, introducer sheath (!24Fr vs.24Fr), access vessel diameters, and access method, female gender was significantly associated with the risk of access complications (OR 2.85; p ¼ .038). Brachial artery for access was also found to be an independent predictor of access related complications (OR 8.32; p < .001). Conclusion: This analysis suggests that women may have a higher access related complication rate after TEVAR, irrespective of the clinical setting, type of aortic disease, and device sizing.

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Section: Discussionmentioning

confidence: 62%

Gender Related Access Complications After TEVAR: Analysis from the Retrospective Multicentre Cohort GORE® GREAT Registry Study

Lomazzi

Mascoli

Beaufort

et al. 2020

European Journal of Vascular and Endovascular Surgery

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“…15 More contemporary studies of TEVAR have shown similar readmission rates of 9% to 11% for patients with NCKD, although readmission data for patients with renal insufficiency are sparse in the existing literature. [15][16][17] In the present study, 1 in 5 patients with ESRD TEVAR, nearly double that rate of patients with NCKD, were readmitted within 30 days. Although we found urgency of the operation to be a major driver of readmission, we have also demonstrated that the presence of even moderate renal insufficiency has a real and adverse impact on rehospitalization after TEVAR.…”

Section: Commentmentioning

confidence: 43%

National Study of Index and Readmission Mortality and Costs for Thoracic Endovascular Aortic Repair in Patients With Renal Disease

Sanaiha

Kavianpour

Downey

et al. 2020

The Annals of Thoracic Surgery

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Background. In the current era of value-based health care delivery, an understanding of patient populations at greatest risk for mortality, complications, and readmissions after thoracic endovascular aortic repair (TEVAR) is warranted. Thus, the present study aimed to evaluate outcomes after TEVAR for patients with varying degrees of renal dysfunction.Methods. All patients who underwent TEVAR from 2010 to 2015 in the Nationwide Readmissions Database were identified. These patients were further stratified into four groups: no chronic kidney disease (NCKD), chronic kidney disease (CKD) stages 1 to 3 (CKD1-3), CKD 4 to 5 (CKD4-5), and end-stage renal disease (ESRD) requiring dialysis. Multivariable regression analysis was used to study index mortality, early (30 days) and intermediate (31-90 days) readmissions, costs, and length of stay. Kaplan-Meier analyses were performed to compare readmission performance among all four groups.Results. An estimated 121,046 patients underwent TEVAR with 26,653 (22.1%) being elective. Patients with

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“…Others have reported rates of 10.4% and 11% after TEVAR and OSR, respectively, in patients with aortic disease. 27 , 28 …”

Section: Discussionmentioning

confidence: 99%

Nationwide database analysis of one-year readmission rates after open surgical or thoracic endovascular repair of Stanford Type B aortic dissection

et al. 2022

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Readmissions after thoracic endovascular aortic repair

Cited by 15 publications

References 25 publications

Gender Related Access Complications After TEVAR: Analysis from the Retrospective Multicentre Cohort GORE® GREAT Registry Study

Gender Related Access Complications After TEVAR: Analysis from the Retrospective Multicentre Cohort GORE® GREAT Registry Study

National Study of Index and Readmission Mortality and Costs for Thoracic Endovascular Aortic Repair in Patients With Renal Disease

Nationwide database analysis of one-year readmission rates after open surgical or thoracic endovascular repair of Stanford Type B aortic dissection

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