Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2024 Sep 12;24(1):259.
doi: 10.1186/s12893-024-02555-4.

Efficacy of thoracic endovascular aortic repair versus medical therapy for treatment of type B aortic dissection

Karam R Motawea  1 , Samah S Rouzan  1 , Rowan H Elhalag  1 , Abdelrhaman M Abdelwahab  1 , Hussam Al Hennawi  2 , Salem Elshenawy  1 , Mai Saad Mohamed  1 , Pensée Chébl  1 , Mohamed Salem Madian  1 , Mostafa Elsayed Elsayed Hewalla  1 , Sarya Swed  3 , Wael Hafez  4   5 , Bisher Sawaf  6 , Samer Kaspo  6 , Naim Battikh  7 , Mohammed Najdat Seijari  6 , Amr Farwati  6 , Amine Rakab  8
Affiliations
Meta-Analysis

Efficacy of thoracic endovascular aortic repair versus medical therapy for treatment of type B aortic dissection

Karam R Motawea et al. BMC Surg. .

Abstract

Background: Techniques in endovascular therapy have evolved to offer a promising alternative to medical therapy alone for Type B aortic dissections (TBADs).

Aim: The aim of this meta-analysis was to compare mortality and overall complications between thoracic endovascular aortic repair (TEVAR) and best medical therapy (BMT) in patients with TBADs.

Methods: We included randomized control trials and prospective or retrospective cohort studies that compared TEVAR and BMT for the treatment of type B aortic dissection. Multiple electronic databases were searched.

Results: Thirty-two cohort studies including 150,836 patients were included. TEVAR was associated with a significantly lower 30-day mortality rate than BMT (RR = 0.79, CI = 0.63, 0.99, P = 0.04), notably in patients ≥ 65 years of age (RR = 0.78, CI = 0.64, 0.95, P = 0.01). The TEVAR group had a significantly prolonged hospital stay (MD = 3.42, CI = 1.69, 5.13, P = 0.0001) and ICU stay (MD = 3.18, CI = 1.48, 4.89, P = 0.0003) compared to the BMT. BMT was associated with increased stroke risk (RR = 1.52, CI = 1.29, 1.79, P < 0.00001). No statistically significant differences in late mortality (1, 3, and 5 years) or intervention-related factors (acute renal failure, spinal cord ischemia, myocardial infarction, respiratory failure, and sepsis) were noted between the groups.

Conclusion: Our meta-analysis revealed a significant association between the TEVAR group and a decreased mortality rate of TBAD compared to the medical treatment group, especially in patients aged 65 years or older. Further randomized controlled trials are needed to confirm our findings.

Keywords: Medical therapy; Thoracic endovascular aortic repair; Type B aortic dissection.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram
Fig. 2
Fig. 2
In hospital / 30-day Mortality Rate
Fig. 3
Fig. 3
In hospital / 30-day Mortality subgroup analysis according to age
Fig. 4
Fig. 4
In hospital / 30-day Mortality subgroup analysis according to complicated or uncomplicated AD
Fig. 5
Fig. 5
In hospital / 30-day Mortality subgroup analysis according to quality
Fig. 6
Fig. 6
Late mortality rate analysis
Fig. 7
Fig. 7
Length of hospital stay analysis
Fig. 8
Fig. 8
Length of ICU stay analysis
Fig. 9
Fig. 9
Retrograde type A dissection analysis
Fig. 10
Fig. 10
Reintervension / dissection related admission analysis
Fig. 11
Fig. 11
Aortic remodeling analysis
Fig. 12
Fig. 12
Respiratory failure analysis
Fig. 13
Fig. 13
Extension or dilatation of dissection / new dissection
Fig. 14
Fig. 14
Aortic rupture
Fig. 15
Fig. 15
Sepsis analysis
Fig. 16
Fig. 16
Chest pain analysis
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Tang JH, Lo ZJ, Wong J, Hong Q, Yong E, Chandrasekar S, et al. Effect of thoracic endovascular aortic repair on aortic remodeling in patients with type B aortic dissection in an Asian population. Ann Vasc Surg. 2020;69:352–9. 10.1016/j.avsg.2020.05.058 - DOI - PubMed
    1. de Grubb MCM, Kilbourne B, Kilbourne K, Langston M, Gittner L, Zoorob RJ, et al. Socioeconomic, environmental, and geographic factors and US lung cancer mortality, 1999‐2009. Family Medicine and Community Health. 2017;5(1):3–12.
    1. Nauta FJ, Trimarchi S, Kamman AV, Moll FL, Van Herwaarden JA, Patel HJ, et al. Update in the management of type B aortic dissection. Vasc Med. 2016;21(3):251–63. 10.1177/1358863X16642318 - DOI - PubMed
    1. Williamson AJ, Sankary S, Kuchta KM, Gaines S, Morcos O, Lind B, Pocivavsek L, Dua A, Lee CJ. Contemporary Unplanned Readmission Trends Following Management of Type B Aortic Dissection. Vasc Specialist Int. 2022;38:16. 10.5758/vsi.220007. - PMC - PubMed
    1. De Bakey ME, Henly WS, Cooley DA, Morris GC Jr, CrawfordBeall ES AC Jr, et al. Surgical management of dissecting aneurysms of the aorta. J Thorac Cardiovasc Surg. 1965;49(1):130–49. 10.1016/S0022-5223(19)33323-9 - DOI - PubMed

MeSH terms

LinkOut - more resources