National Trends in the Use and Timing of Thoracic Endovascular Aneurysm Repair After Type B Aortic Dissection.

The optimal management of uncomplicated type B aortic dissection (TBAD) has become controversial in recent years, especially concerning the use and timing of thoracic endovascular aneurysm repair (TEVAR). Here, we analyze a large national cohort over 11 years to understand the current national landscape of TBAD management, trends over time, and disparities in care across the United States. Admissions for acute TBAD from 2010 to 2020 were identified in the Nationwide Readmissions Database, a large nationally representative sample of hospital admissions across 30 states. Patients were tracked through the calendar year to understand midterm treatment strategies after TBAD, specifically the use and timing of TEVAR. Overall, 10,628 patients with acute TBAD were identified, of whom 7483 (70.4%) were discharged alive after upfront medical management. Among medically managed TBAD patients, 8.8% underwent interval TEVAR by 300 days. In addition to age and comorbidity burden, residence in a low-income ZIP Code (odds ratio, 0.75; 95% CI, 0.61-0.91; P = .004) and treatment at a teaching hospital (odds ratio, 1.29; 95% CI, 1.01-1.66; P = .042) were independently associated with the likelihood of interval TEVAR. Among all TBADs treated with TEVAR nationally from 2010 to 2019, a clear year-by-year trend toward greater use of TEVAR in the postacute period was observed (P = .004). Among all TEVARs for TBAD nationally, 40% were performed >14 days after dissection in 2019 compared with 17% in 2010. Nationally, interval TEVAR after medically managed TBAD has become much more common, although important disparities remain in its use.