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THE JOURNAL OF CARDIOVASCULAR SURGERY

A Journal on Cardiac, Vascular and Thoracic Surgery


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ORIGINAL ARTICLE  VASCULAR SECTION


The Journal of Cardiovascular Surgery 2017 December;58(6):835-44

DOI: 10.23736/S0021-9509.16.08124-6

Copyright © 2014 EDIZIONI MINERVA MEDICA

language: English

Contemporary economic and clinical evaluations of endovascular repair for intact descending thoracic aortic aneurysms

Roberto SILINGARDI 1 , Stefano GENNAI 1, Giovanni COPPI 1, Johanna CHESTER 1, Luigi MARCHESELLI 2, Massimo BRUNETTI 3

1 Department of Vascular Surgery, University of Modena and Reggio Emilia, Nuovo Ospedale S. Agostino Estense, Modena, Italy; 2 Department of Oncology and Hematology, University of Modena and Reggio Emilia, Reggio Emilia, Italy; 3 Regional Sanitary Service for Emilia Romagna, Local Sanitary Unit, Modena, Italy


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BACKGROUND: The aim of this study was to assess clinical and contemporary costs associated with elective endovascular repair of intact descending thoracic aortic aneurysms (DTAA) into the mid-term follow-up.
METHODS: A retrospective review of a prospectively maintained clinical database including 29 consecutive patients from July 2005 to December 2009 treated with elective endovascular repair (TEVAR) or TEVAR and surgical infrarenal repair (hybrid) of intact DTAA was performed. Mean age was 74.5 years old (±7.1). Primary clinical endpoints include mortality and major morbidity. Additionally a comprehensive economic appraisal of individual in-hospital and follow-up costs was executed. Economic endpoints include in-hospital and follow-up costs and patient discharge status. Elective endovascular and open repairs’ clinical and economical outcomes in contemporary literature were assessed for comparison according to PRISMA standards.
RESULTS: Immediate mortality was 6.9% (1/24 TEVAR and 1/5 hybrid). Three respiratory complications were recorded (11%; 2 TEVAR, 1 hybrid). Renal and cardiac complication rates were 7.4% (1 TEVAR, 1 hybrid) and 3.7% (1 TEVAR) respectively. Routine discharge home was achieved for 85% of patients (95.7% TEVAR, 25% hybrid). Three endoleaks were treated throughout the follow-up (2 TEVAR, 1 hybrid; mean 30.4 mo, ±19.9) rendering an 11% (3/27) reintervention rate. Average immediate cost was €21,976.87 for elective endovascular repair and €33,783.21 for elective endovascular hybrid repair. Additional reintervention and routine follow-up costs augmented immediate costs by 12.4%.
CONCLUSIONS: This study supports satisfying immediate clinical outcomes for TEVAR and TEVAR+surgical infrarenal procedures. Although limited by a small population size and difficulties in economic comparisons, this study presents the real world social and economic cost scenario for both elective TEVAR and TEVAR hybrid treatment of DTAA of both the in-hospital and at mid term follow-up periods.


KEY WORDS: Aortic Aneurysm, Thoracic - Thoracic surgery - Costs and Cost Analysis - Health care costs - Angioplasty

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Publication History

Issue published online: September 14, 2017
Article first published online: October 17, 2014
Manuscript accepted: October 15, 2014
Manuscript revised: July 31, 2014
Manuscript received: January 15, 2014

Cite this article as

Silingardi R, Gennai S, Coppi G, Chester J, Marcheselli L, Brunetti M. Contemporary economic and clinical evaluations of endovascular repair for intact descending thoracic aortic aneurysms. J Cardiovasc Surg 2017;58:835-44. DOI: 10.23736/S0021-9509.16.08124-6

Corresponding author e-mail

chirvascmo@gmail.com