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P Narayan, A Wong, I Davies, A J Bryan, P Wilde, G J Murphy

Does TEVAR provide a financial benefit for management of descending thoracic aortic pathologies?. P Narayan, A Wong, I Davies, A J Bryan, P Wilde, G J Murphy. Background Management of descending aortic pathology is a complex and challenging area

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P Narayan, A Wong, I Davies, A J Bryan, P Wilde, G J Murphy

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  1. Does TEVAR provide a financial benefit for management of descending thoracic aortic pathologies? P Narayan, A Wong, I Davies, A J Bryan, P Wilde, G J Murphy

  2. Background Management of descending aortic pathology is a complex and challenging area Surgical management is indicated in specific situations Endo-Vascular Surgical Repair [TEVAR] provides another important option Aim To assess early and mid term outcomes of TEVAR compared with surgical repair To compare the financial implications of TEVAR and surgical management

  3. Methods • Retrospective study • Time period: April 1996- February 2009 • 85 procedures Surgical repair: 35 TEVAR: 49 • Data accessed from computerised database –PATS System and validated by case note reviews • Hospital costs calculated from NHS reference costs for staff time, consumables, transfusion and length of stay.

  4. Statistical Analysis • Data tabulated as N(%) for categorical data and median (inter-quartile range) for continuous data • Continuous variables analysed with Mann Whitney U test • Categorical variables analysed with Fisher’s exact test or Chi-square • Kaplan-Meier estimates were used to compare re- intervention and survival

  5. Trends in the Management of Descending Thoracic Aortic Pathology

  6. Patient Characteristics

  7. Procedural Characteristics

  8. In Hospital Clinical Outcome

  9. Hospitalisation Costs of EVAR versus Surgery

  10. Mid-term Follow-up

  11. Mid-term Outcomes of TEVAR and Surgery for Diseases of the Descending Thoracic Aorta Re-intervention Mortality Log Rank p=0.002 Log Rank p=0.901 TEVAR TEVAR Surgery Surgery

  12. Conclusions • TEVAR is associated with superior short-term results • Mid term survival is similar to surgery • Re-intervention rate is significantly higher in TEVAR • Resource utilisation is similar in both groups for the primary procedure • Costs may prove to be higher in the TEVAR group with re-interventions

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