Contemporary trends in practice patterns and clinical outcomes of thoracic endovascular aortic repair for nontraumatic thoracic aortic disease in the Vascular Quality Initiative

Introduction: The purpose of this analysis was to document longitudinal changes in thoracic endovascular aortic repair practice patterns and clinical outcomes, using data from the Vascular Quality Initiative. Methods: All patients who underwent elective or nonelective thoracic endovascular aortic repair from 2015 to 2023 were reviewed (N = 23,532). The primary outcomes were in-hospital mortality and long-term survival. Secondary outcomes included in-hospital major complications and postoperative spinal cord ischemia. Procedures were classified into 3 time periods: early (2015–2017), middle (2018–2020), and late (2021–2023). Results: Among elective procedures, a significant trend toward an increased proportion of dissection and penetrating aortic ulcer/intramural hematoma indications being treated over time was noted. Overall crude incidence of postoperative complications decreased significantly (25% vs 23% vs 21%; P < .001). In risk-adjusted analysis, incidence of any in-hospital complication declined for elective procedures, as well as nonelective cases (odds ratio, 0.93–0.96; 95% confidence interval, 0.92–0.98; P = .002). In particular, risk of spinal cord ischemia decreased after elective procedures (odds ratio, 0.96; 0.92–0.99; P = .03) but showed no change for nonelective cases despite an overall decrease in preoperative spinal drain use (41% vs 33% vs 23%; P < .001). Overall, unadjusted rates of in-hospital death did not vary significantly between time periods (5.8% vs 5.4% vs 5.4%; P = .45). However, in risk-adjusted analysis, in-hospital mortality risk decreased longitudinally after elective surgery (odds ratio, 0.94; 0.9–0.98; P = .001) but not for nonelective cases (P = .13). Cox regression analysis showed improved long-term survival for elective cases (hazard ratio, 0.96; 0.94–0.99; P = .02) but no change for nonelective procedures. Conclusion: This analysis offers contemporary insights into thoracic endovascular aortic repair practice patterns and clinical outcomes, providing valuable benchmarking information for stakeholders focused on enhancing care delivery for this complex patient population.