title: Contemporary economic and clinical evaluations of endovascular repair for intact descending thoracic aortic aneurysms.
abstract: 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.
authors.affiliation: Department of Vascular Surgery, University of Modena and Reggio Emilia, Nuovo Ospedale S. Agostino Estense, Modena, Italy - chirvascmo@gmail.com.
authors.forename: Roberto
authors.initials: R
authors.lastname: Silingardi
authors.affiliation: Department of Vascular Surgery, University of Modena and Reggio Emilia, Nuovo Ospedale S. Agostino Estense, Modena, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Gennai
authors.affiliation: Department of Vascular Surgery, University of Modena and Reggio Emilia, Nuovo Ospedale S. Agostino Estense, Modena, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Coppi
authors.affiliation: Department of Vascular Surgery, University of Modena and Reggio Emilia, Nuovo Ospedale S. Agostino Estense, Modena, Italy.
authors.forename: Johanna
authors.initials: J
authors.lastname: Chester
authors.affiliation: Department of Oncology and Hematology, University of Modena and Reggio Emilia, Reggio Emilia, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Marcheselli
authors.affiliation: Regional Sanitary Service for Emilia Romagna, Local Sanitary Unit, Modena, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Brunetti
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000191:economics* / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D016208:Databases, Factual; D017558:Elective Surgical Procedures / Q000191:economics; D057510:Endovascular Procedures / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D005260:Female; D017048:Health Care Costs; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D018803:Models, Economic; D011183:Postoperative Complications / Q000191:economics / Q000628:therapy; D017064:Process Assessment, Health Care / Q000191:economics*; D019233:Retreatment / Q000191:economics; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome