# Thoracic Endovascular Aortic Repair Using Stent Grafts in Japan

## TL;DR

Stent-graft technology for thoracic aortic repair in Japan significantly increased surgical procedures and improved patient outcomes over two decades.

## Contribution

This study quantifies the impact of stent-graft adoption on thoracic endovascular aortic repair (TEVAR) in Japan, showing its role in expanding surgeries and reducing mortality.

## Key findings

- TEVAR cases increased from 0 in 1999 to 6461 in 2019, with a 28.5% adoption rate.
- 30-day mortality for ruptured aneurysms dropped to 13.9% with TEVAR in 2019.
- TEVAR reduced 30-day mortality to 5.7% in acute type B aortic dissection cases.

## Abstract

A stent-graft technique was developed by Parodi et al. and has been used clinically for thoracic endovascular aortic repair (TEVAR) since the 1990s. We evaluated how the new stent-graft technology contributed to expanding aortic surgery and improving surgical outcomes of aortic surgery. TEVAR was performed in a limited number of institutes in the early 2000s and was greatly enhanced by the approval of commercially available stent grafts in 2008. Its performance increased steadily thereafter, with 0 cases performed in 1999, 1658 in 2009, and 6461 in 2019. The ratio of TEVAR was 0% in 1999, which increased to 13.9% in 2009 and 28.5% in 2019, respectively. TEVAR has greatly contributed to the improvement of surgical outcomes, especially in non-dissection ruptured aneurysms and type B acute aortic dissection. TEVAR was performed in 53% of ruptured aneurysms, and the 30-day mortality rate improved to 13.9% in 2019 due to a 30-day mortality rate of 12.5% in TEVAR. The effect of TEVAR was more remarkable in patients with acute type B aortic dissection, where the 30-day mortality rate was 5.7%, and the procedure was performed in 75% of cases. The overall 30-day mortality rate improved to 7.0% for all patients with type B acute aortic dissection in 2019. The expansion of TEVAR using stent grafts greatly increased the number of aortic surgeries and played a significant role in improving surgical outcomes. Stent-graft technology has influenced the field of aortic surgery.