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Thoracic endovascular aortic repair or best medical therapy for uncomplicated type B aortic dissection? A
Jue Yang1, Yun Shi1, Junhao Jiang2
1Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Introduction:
The aim of this meta-analysis was to investigate all studies comparing thoracic endovascular aortic repair (TEVAR) and best medical therapy (BMT) for the treatment of uncomplicated type B aortic dissection (TBAD).
Evidence Acquisition:
PubMed/Medline and Web of Knowledge were searched until September 2014 for relevant studies published in English. Pooled odds ratio (OR) and its corresponding 95% CI were analyzed with Cochrane Review Manager (RevMan v.5.3).
Evidence Synthesis:
Our analysis showed that compared with BMT, TEVAR did not significantly affect 30-day (hospital) mortality. A significantly lower 1-year and 2- or 3-year survival rates was observed with TEVAR vs. BMT. Interestingly, a trend just short of statistical significance towards higher 4- or 5-year survival was found with TEVAR treatment (P=0.08). No significant differences were found in false lumen (FL) thrombosis formation with TEVAR vs. BMT treatment. However, a trend toward less incomplete or no FL thrombosis was noted with TEVAR. No significantly impact on the risk of later re-intervention was found with TEVAR vs. BMT.
Conclusions:
TEVAR did not provide obvious early survival advantage for uncomplicated TBAD over BMT, especially in the patients using TEVAR alone. It may remain a treatment option in uncomplicated TBAD patients with high risks for later complications. More randomized, prospective, long-term studies are needed to further clarify whether TEVAR could be a better first-line treatment strategy vs. BMT for uncomplicated TBAD.
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