INTRODUCTION
Ever since its first description in 1994 by Dake and colleagues, thoracic endovascular aortic repair (TEVAR) has become the standard of care for the treatment of various pathologies involving the descending thoracic aorta (DTA), including aneurysm, acute dissection, intramural hematoma, and aortic rupture . Aided by technological advances and increasing operator familiarity with endovascular approaches, TEVAR has been associated with improved short-term outcomes compared to open surgical repair, including operative mortality, spinal cord ischemia, acute kidney injury, and cardiac and pulmonary complications
Nevertheless, access to surgical procedures and their benefits is often inequitable due to structural disparities at the health systems level . For example, racial disparities have persisted in the utilization of 9 major surgical procedures, including coronary angioplasty, spinal fusion, carotid endarterectomy, appendectomy, colorectal resection, coronary artery bypass grafting, total hip arthroplasty, total knee arthroplasty, and worsened for one-third of them from 2012-2017 period . Likewise, the Transcatheter Valve Therapy (TVT) Registry suggests minorities have been underrepresented among the recipients of transcatheter aortic valve replacement (TAVR) .
However, the incursion of TEVAR technology into medical practice suggested a process of ”democratizing technology.” Historically, black patients were more likely to undergo open repair for thoracic aortic aneurysms (TAA) at low-volume hospitals with higher operative mortality than white patients (13). This paradigm was challenged by two reports, including data from 1999 to 2008, were we could observed a setting-off of traditional racial disparities with TEVAR utilization . Given that more than a decade has already passed, our objective is to reevaluate if TEVAR continues to be a procedure where access to surgical services is not affected by racial differences using a contemporary database.