{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T18:58:53Z","timestamp":1785265133844,"version":"3.55.0"},"reference-count":48,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T00:00:00Z","timestamp":1754265600000},"content-version":"unspecified","delay-in-days":3,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003478","name":"Ministry of Health, Labour and Welfare","doi-asserted-by":"publisher","award":["JPMH20FA1018"],"award-info":[{"award-number":["JPMH20FA1018"]}],"id":[{"id":"10.13039\/501100003478","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003478","name":"Ministry of Health, Labour and Welfare","doi-asserted-by":"publisher","award":["JPMH23KC2002"],"award-info":[{"award-number":["JPMH23KC2002"]}],"id":[{"id":"10.13039\/501100003478","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009619","name":"Japan Agency for Medical Research and Development","doi-asserted-by":"publisher","award":["JP24mk0121299"],"award-info":[{"award-number":["JP24mk0121299"]}],"id":[{"id":"10.13039\/100009619","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["JP18K12134"],"award-info":[{"award-number":["JP18K12134"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["JP23K07536"],"award-info":[{"award-number":["JP23K07536"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Surg Interv Health Technologies"],"accepted":{"date-parts":[[2025,7,8]]},"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To compare the long-term outcomes of initial thoracic endovascular aortic repair (TEVAR) versus initial medical therapy (iMT) in patients with acute uncomplicated type B aortic dissection (uTBAD), using real-world evidence from a nationwide claims database in Japan. This study aligns with stage 4 of the Idea, Development, Exploration, Assessment, and Long-term Study (IDEAL) framework for surgical innovation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A retrospective cohort study using propensity score matching (PSM) to balance baseline characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Japanese nationwide health insurance claims database, between 1 January 2015 and 31 December 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Among 40\u2009229 cases with tentative codes for aortic dissection (International Classification of Diseases-10: I71.0), 4995 met all eligibility criteria for acute uTBAD. Among these patients, 96 underwent TEVAR in the subacute phase (15\u201390 days post diagnosis), while 4899 were managed with iMT. After PSM, 96 TEVAR cases were matched to 480 iMT cases in a 1:5 ratio.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>The primary outcomes were aorta-related events and all-cause mortality. The secondary outcome was the frequency of follow-up CT imaging every year.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>After PSM, the baseline characteristics of both groups were balanced. Median age was 56 years (IQR: 50\u201362 years) in both groups, and follow-up duration was similar (TEVAR: 31 months; iMT: 28 months, p=0.84).<\/jats:p>\n                    <jats:p>At 60 months, Kaplan-Meier estimates showed an aorta-related event rate of 21.9% (95% CI: 12.6% to 36.4%) for TEVAR and 19.9% (95% CI: 15.6% to 25.2%) for iMT (p=0.99).<\/jats:p>\n                    <jats:p>All-cause mortality was 4.4% (95% CI: 1.4% to 13.6%) for TEVAR and 6.6% (95% CI: 4.0% to 10.6%) for iMT (p=0.70). No significant differences were observed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>While aorta-related events accumulated steadily in the crude iMT group, no survival benefit was observed for subacute TEVAR. These findings support ongoing randomized controlled trials and show the utility of claims-based analyses in IDEAL Stage 4.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjsit-2024-000361","type":"journal-article","created":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T18:25:18Z","timestamp":1754331918000},"page":"e000361","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Long-term outcomes of initial thoracic endovascular repair versus medical therapy in acute uncomplicated type B aortic dissection: real-world evidence from a nationwide claims database in Japan \u2013 a retrospective cohort study"],"prefix":"10.1136","volume":"7","author":[{"given":"Yuki","family":"Kimura","sequence":"first","affiliation":[{"name":"Clinical Pharmacology and Regulatory Science, Juntendo University School of Medicine Graduate School of Medicine, Bunkyo-ku, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3261-8828","authenticated-orcid":false,"given":"Hiroshi","family":"Ohtsu","sequence":"additional","affiliation":[{"name":"Clinical Pharmacology and Regulatory Science, Juntendo University School of Medicine Graduate School of Medicine, Bunkyo-ku, Japan"},{"name":"Faculty of Health Data Science, Juntendo University, Urayasu-city, Japan"},{"name":"Institute for Medical Regulatory Science, Comprehensive Research Organization, Waseda University, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3637-2095","authenticated-orcid":false,"given":"Naohiro","family":"Yonemoto","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Faculty of Medicine, University of Toyama, Toyama, Japan"},{"name":"Department of Public Health, Juntendo University School of Medicine Graduate School of Medicine, Bunkyo-ku, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuyoshi","family":"Azuma","sequence":"additional","affiliation":[{"name":"Division of Vascular, Respiratory and Surgical Oncology, Asahikawa Medical University, Hokkaido, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2714-304X","authenticated-orcid":false,"given":"Kazuhiro","family":"Sase","sequence":"additional","affiliation":[{"name":"Clinical Pharmacology and Regulatory Science, Juntendo University School of Medicine Graduate School of Medicine, Bunkyo-ku, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,8,4]]},"reference":[{"key":"2026011310322173000_7.1.e000361.1","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1016\/S0140-6736(22)01970-5","article-title":"Acute aortic dissection","volume":"401","author":"Carrel","year":"2023","journal-title":"Lancet"},{"key":"2026011310322173000_7.1.e000361.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.07.063"},{"key":"2026011310322173000_7.1.e000361.3","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.113.000463"},{"key":"2026011310322173000_7.1.e000361.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2014.05.012"},{"key":"2026011310322173000_7.1.e000361.5","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.622340"},{"key":"2026011310322173000_7.1.e000361.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2013.05.003"},{"key":"2026011310322173000_7.1.e000361.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2016.06.005"},{"key":"2026011310322173000_7.1.e000361.8","doi-asserted-by":"crossref","first-page":"1231","DOI":"10.1016\/j.jtcvs.2021.11.091","article-title":"The Society of Thoracic Surgeons\/American Association for Thoracic Surgery clinical practice guidelines on the management of type B aortic dissection","volume":"163","author":"MacGillivray","year":"2022","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026011310322173000_7.1.e000361.9","doi-asserted-by":"crossref","unstructured":"Isselbacher EM , Preventza O , Hamilton Black J , et al . 2022 ACC\/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association\/American College of Cardiology Joint Committee on Clinical Practice Guidelines. 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