Endovascular repair versus best medical treatment for uncomplicated acute type B acute aorta dissection: a meta-analysis.

Abstract

Introduction: In acute type B aortic dissection (TBAD) patients, thoracic endovascular aorta repair (TEVAR) and best medical treatment (BMT) have both been employed for the clinical management of this condition. The relative efficacy of TEVAR and BMT when used to manage cases of acute uncomplicated TBAD, however, remains to be clarified.

Aim: To conduct a pooled meta-analysis comparing acute uncomplicated TBAD patient outcomes associated with primary TEVAR or BMT treatment.

Material and methods: Relevant articles published up to July 2023 were identified by searching the Web of Science, PubMed, and Wanfang databases. Pooled analyses of endpoints from these studies were then conducted.

Results: Six relevant studies were included in this meta-analysis, involving 522 and 535 patients who underwent TEVAR and BMT treatment, respectively. No significant differences were observed between these two groups with respect to pooled hospitalization duration, re-intervention rates, early mortality, organ failure incidence, stroke incidence, or the incidence of retrograde type A dissection (p = 0.89, 0.12, 0.09, 0.36, 0.09, and 0.95, respectively). TEVAR, however, was associated with significantly better pooled thrombosed/obliterated false lumen, late mortality, aorta-related mortality, and rupture rates relative to BMT (p = 0.00001, 0.002, 0.0001, and 0.04, respectively). TEVAR was associated with a 7% pooled type I endoleak incidence rate. Endpoints exhibiting significant heterogeneity included hospitalization duration, thrombosed/obliterated false lumen rates, and rupture rates (I ² = 96%, 73%, and 61%, respectively).

Conclusions: While TEVAR and BMT yield similar short-term outcomes for acute uncomplicated TBAD patients, TEVAR may be associated with a better long-term patient prognosis.