title: Incidence of descending aortic pathology and evaluation of the impact of thoracic endovascular aortic repair: a population-based study in England and Wales from 1999 to 2010.
abstract: OBJECTIVE
  To investigate population trends in thoracic aortic disease (dissections and aneurysms) in England and Wales, with focus on the impact of thoracic endovascular aortic repair on procedure numbers and age at repair.
  
  
  METHODS
  Routine hospital statistics of England and Wales provided admission, procedure and mortality data from 1999 to 2010. All data were age-standardised, reported per 100,000 population, by age bands (>50 years or 50-74 years versus 75+ years) and gender. Only patients 50+ years were included, to focus on degenerative disease.
  
  
  RESULTS
  Between 1999 and 2010 hospital admissions for total (ascending and descending) have risen steadily for thoracic aortic dissection (TAD) from 7.2 to 8.8 and thoracic aortic aneurysm (TAA) from 4.4 to 9.0, principally attributable to increased admissions in those 75+ years. Total mortality declined steadily over the same period, for TAD from 4.4 to 3.2 and for TAA from 10.4 to 7.5. Procedure rates have risen sharply, driven by the implementation of TEVAR from 2006, for type B dissection from 0.06 to 0.53 and for descending TAA from 0.76 to 1.89. All figures are per 100,000 population with P <0.005.
  
  
  CONCLUSIONS
  Improvements in case ascertainment may have contributed to the increase in hospital admissions. The increased application of TEVAR, particularly for dissections, is mainly in those above 75 years and has not yet translated into an accelerated survival benefit.
authors.affiliation: Vascular Surgery Research Group, Imperial College, Charing Cross Campus, St Dunstan's Road, London W6 8RF, UK. r.von-allmen@imperial.ac.uk
authors.forename: R S
authors.initials: RS
authors.lastname: von Allmen
authors.forename: A
authors.initials: A
authors.lastname: Anjum
authors.forename: J T
authors.initials: JT
authors.lastname: Powell
mesh_terms: D000367:Age Factors; D000368:Aged; D000784:Aortic Dissection / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D012737:Sex Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D014852:Wales / Q000453:epidemiology