OBJECTIVES: Thoracic endovascular aortic repair (TEVAR) with stent grafting is a minimally invasive modality for treating thoracic aortic aneurysm, including dissection and rupture. Location of stent graft placement (i.e., “landing zone”) is an important anatomic consideration. Procedure codes in health care claims data do not specify or distinguish TEVAR landing zones, which is a critical limitation in conducting health economics and outcomes research about aortic repair. Using revascularization procedure codes in commercial claims data coincident with codes for TEVAR, we were able to retrospectively estimate location of stent grafts placed in aortic zones 0, 1 or 2.

METHODS: Patients with aortic aneurysm, dissection or rupture who underwent an inpatient TEVAR procedure between 1/1/2016 and 1/31/2023 were identified using MERATIVE MARKETSCAN^® Treatment Pathways, an online query tool that allows researchers to access data about cohorts of patients based on International Classification of Diseases, Tenth Revision (ICD‐10) diagnosis and procedure codes, Current Procedural Terminology (CPT^®) codes and place and date of service. Landing zone identification was determined by supra-aortic revascularization procedure codes and aortic repair/replacement procedure codes associated with hybrid TEVAR.

RESULTS: A total of 1,484 TEVAR patients were identified in the data; 405 (27.3%) had revascularization in any zone or multiple zones (i.e., revascularization occurred in Zone 0, Zone 1, and/or Zone 2), while 1,079 (72.7%) of TEVAR patients had no revascularization. Among the patients with revascularization, 132 (32.6%) were estimated to have had stent graft placement in Zone 0, while 193 (47.7%) and 80 (19.8%) likely had stent grafts landing in Zones 1 and 2, respectively.

CONCLUSIONS: Understanding location of placement of aortic stent grafts is important to evaluate their clinical effectiveness and associated costs. Results from this study demonstrate that commercial claims data can be effectively used to generalize location of TEVAR stent graft placement in the thoracic aorta.