The Outcomes of Thoracic Endovascular Aortic Repair in Japan in 2017: A Report from the Japanese Committee for Stentgraft Management

Thoracic endovascular aortic repair (TEVAR) was initially used in treating descending thoracic aortic aneurysms back in 1992.1) It was then approved by the United States Food and Drug Administration in 2005. Since then, TEVAR has been adopted worldwide and has been improved dramatically, both procedurally and in terms of available materials. In Japan, TEVAR is identified as the standard treatment for descending thoracic aneurysms.2) The emergence of fenestrated stent grafts to better fit the angulated morphology of the thoracic arch and of the lower profile and the 2015 approval of TEVAR for aortic dissection have led to an increase in the annual number of TEVAR procedures performed in Japan. However, the outcomes of TEVAR are yet to be evaluated in a large cohort. Thus, in this study, we aim to report the number of TEVAR procedures conducted in Japan in 2017, including its mortality and complication rates, by using the data from the Japanese Committee for Stentgraft Management (JACSM) nationwide registry; this data covers the outcomes of nearly all of the stent grafts shipped to Japan.3,4) JACSM and database The JACSM nationwide registry, including its foundations, structure, and quality control, has already been previously described in detail.3,4) The JACSM, established in December 2006, is composed of 10 societies related to endovascular treatment and determined the practical standards for institutions and for practicing and supervising surgeons. Participating institutions were obligated to report their data on endovascular aneurysm repair (EVAR) and TEVAR, using a web-based case-registry form (http://www.stentgraft.jp/). The information collected as regards TEVAR included preoperative information, anatomical factors evaluated during operative planning, and data obtained in the immediate postoperative period, at discharge, at 6 months postoperative, and at each year after that. As of 2015, 366 institutes in Japan had been certified for TEVAR by the JACSM. This registry was conducted in accordance to the principles of the Declaration of Helsinki, the International Conference on Harmonization, and Good Clinical Practice guidelines. The use of registry data was approved by the Institutional Review Board of the University of Tokyo Hospital (approval number: 2019306NI).