Presentation (CTI)

OBJECTIVES: Endovascular repair of the thoracic aorta (TEVAR) is indicated for pathologies of the descending thoracic aorta, combined with revascularization surgery of the left subclavian artery (LSAre) when anchoring the stent graft requires coverage of the LSA ostium. These two procedures can be performed simultaneously or consecutively. The aim of this study was to describe the current hospital management of patients undergoing combined procedures in France between 2018 and 2023, based on PMSI data.
METHODS: All adults undergoing TEVAR and LSAre procedures concomitantly or within 60 days before or after the TEVAR between 2018 and 2023 were identified from the PMSI database. The attributes of the TEVAR and LSAre stays, along with patient characteristics, were described. The indication for TEVAR was defined according to the assignment of an ICD10 code for thoracic aortic aneurysm, aortic dissection or traumatic aortic injury.
RESULTS: Between 2018 and 2023, 1,044 patients were identified as having undergone separate TEVAR and LSAre procedures. Median age was 66 years, and over 71% were male. The two main indications for TEVAR were thoracic aortic aneurysm (45.1%) and aortic dissection (47.6%). Over 84% of patients (N= 876) underwent both procedures during one stay, including 64% (N=672) on the same day. The median length of stay was lower when performing the procedures on the same day rather than in two stages (11 days vs 15 days respectively). For patients who had two separate stays (N=168, 16%), the median cumulative length of stay was 12 days. Depending on whether the procedures were performed during one or more stays, the related costs were €28,554 and €34,155 respectively.
CONCLUSIONS: These results provide a better understanding of how the introduction of new, fully endovascular technologies could potentially impact the organization of hospital care, particularly through the reduction of the length of stay and/or the number of hospital stays.