title: National trends and regional variation of open and endovascular repair of thoracic and thoracoabdominal aneurysms in contemporary practice.
abstract: OBJECTIVE
  Successful surgical management of thoracic aortic aneurysms (TAA) and thoracoabdominal aortic aneurysms (TAAA) has historically relied upon open surgical repair (OSR). More recently, the advent and application of thoracic endovascular stent graft aneurysm repair (TEVAR) permutations have become increasingly performed in contemporary practice. To better determine the effect of TEVAR techniques on OSR, we examined national and regional trends in treatment use.
  
  
  METHODS
  All Medicare patients from 1998 through 2007 undergoing isolated TAA and TAAA repair were analyzed using a clinically validated algorithm using diagnostic International Classification of Disease 9th revision (ICD-9; 441.1, 441.2, 441.6, 441.7, 441.9) codes and procedural (ICD-9 OSR: 38.35, 38.45 and TEVAR: 39.73, 39.79) codes. Differential rates of OSR and TEVAR were compared across census tract regions during the study interval.
  
  
  RESULTS
  Total complex aortic repairs increased by 60%, from 10.8 to 17.8/100,000, between 1998 and 2007 (P < .001). A dramatic increase occurred in TEVAR (not performed in 1998, 5.8/100,000 in 2007) during the study period, but OSR rates remained stable during the same interval (10.7 to 12.0/100,000 in 2007, P = NS). There was substantial regional variation for both OSR and TEVAR. This regional variation was greater in OSR (range, 8.8-16.7/100,000) than in TEVAR (range, 4.5-6.9/100,000).
  
  
  CONCLUSIONS
  Degenerative TAA and TAAA aneurysms are being repaired in the United States at an increasing rate. This reflects the rapid acceptance of TEVAR, which apparently supplements rather than supplants OSR. There appears to be greater regional variation in OSR compared with TEVAR. These data may have significant implications for those interested in the effect of new technologies on health care and cost containment.
authors: Section of Vascular Surgery, Shands Hospital-University of Florida, Gainesville, FL 32610-0128, USA. salvatore.scali@surgery.ufl.edu
authors: Salvatore T
authors: ST
authors: Scali
authors: Philip P
authors: PP
authors: Goodney
authors: Daniel B
authors: DB
authors: Walsh
authors: Lori L
authors: LL
authors: Travis
authors: Brian W
authors: BW
authors: Nolan
authors: David C
authors: DC
authors: Goodman
authors: F Lee
authors: FL
authors: Lucas
authors: David H
authors: DH
authors: Stone
references: J Thorac Cardiovasc Surg. 2007 Feb;133(2):369-77
references: 17258566
references: Surgery. 1982 Dec;92(6):1103-8
references: 7147188
references: Ann Thorac Surg. 2008 Jan;85(1 Suppl):S1-41
references: 18083364
references: J Vasc Surg. 2005 Jan;41(1):1-9
references: 15696036
references: Ann Surg. 2002 Oct;236(4):471-9; discussion 479
references: 12368676
references: J Vasc Surg. 2009 Mar;49(3):792-9
references: 19268783
references: J Thorac Cardiovasc Surg. 2010 Nov;140(5):1001-10
references: 20951252
references: Semin Vasc Surg. 2006 Mar;19(1):11-7
references: 16533687
references: Ann Thorac Surg. 2000 Feb;69(2):409-14
references: 10735672
references: Vasc Endovascular Surg. 2011 Jan;45(1):39-45
references: 20829240
references: Semin Vasc Surg. 2010 Sep;23(3):170-5
references: 20826294
references: Am Surg. 2010 Jun;76(6):599-605
references: 20583515
references: J Vasc Surg. 2009 Jul;50(1):54-60
references: 19481407
references: J Vasc Surg. 2010 Dec;52(6):1478-85
references: 20801610
references: J Vasc Surg. 2009 May;49(5):1112-6
references: 19307086
references: J Vasc Surg. 2006 Dec;44(6):1188-97
references: 17145420
references: JAMA. 1998 Apr 22-29;279(16):1278-81
references: 9565008
references: J Vasc Surg. 2004 Oct;40(4):670-9; discussion 679-80
references: 15472593
references: J Vasc Surg. 2009 Aug;50(2):243-50
references: 19446987
references: J Vasc Surg. 2009 Aug;50(2):341-348.e1
references: 19372025
references: J Vasc Surg. 2008 May;47(5):912-8
references: 18353605
references: Am J Surg. 1993 Aug;166(2):186-9; discussion 189-90
references: 8352413
references: J Vasc Surg. 2008 Feb;47(2):247-257; discussion 257
references: 18241743
references: J Vasc Surg. 2010 Oct;52(4):1022-33, 1033.e15
references: 20888533
references: Circ Cardiovasc Qual Outcomes. 2010 Jan;3(1):15-24
references: 20123667
references: J Vasc Surg. 2008 Sep;48(3):546-54
references: 18572352
references: J Vasc Surg. 2008 Oct;48(4):828-35
references: 18657946
references: Ann N Y Acad Sci. 2006 Nov;1085:47-58
references: 17182922
references: J Am Coll Cardiol. 2010 Mar 9;55(10):986-1001
references: 20137879
references: Vasc Endovascular Surg. 2002 Mar-Apr;36(2):105-13
references: 11951097
references: Ann Surg. 2010 Oct;252(4):603-10
references: 20881766
references: Semin Vasc Surg. 2009 Sep;22(3):132-9
references: 19765522
references: J Thorac Cardiovasc Surg. 2010 Jan;139(1):231-2
references: 19691999