Endovascular Repair in High-Risk Uncomplicated Type B Aortic Dissection: A Systematic Review and Single-Arm...

Area of Science:

• Vascular Surgery
• Cardiovascular Research
• Medical Technology Assessment

Background:

• Optimal medical therapy (OMT) alone is associated with poor prognosis in high-risk uncomplicated type B aortic dissection (hrTBAD).
• The role of thoracic endovascular aortic repair (TEVAR) in hrTBAD remains controversial due to potential risks versus benefits in aortic remodeling and complication reduction.

Purpose of the Study:

• To systematically review and meta-analyze early and long-term outcomes of TEVAR in hrTBAD patients.
• To evaluate the safety and efficacy of TEVAR for hrTBAD, addressing uncertainties in current management strategies.

Main Methods:

• Systematic review and single-arm meta-analysis of MEDLINE, Embase, and Cochrane Library up to January 2025.
• Inclusion of 10 retrospective cohort studies (1971 patients) meeting Society for Vascular Surgery criteria for hrTBAD.
• Data synthesis using random-effects models; individual patient data reconstructed from Kaplan-Meier curves.

Main Results:

• Pooled early mortality: 1.22%; stroke: 3.29%; spinal cord ischemia: 1.10%.
• Long-term survival rates: 88.0% at 1 year, 84.0% at 3 years, 77.4% at 5 years; reintervention rate: 6.63%.
• Favorable aortic remodeling observed, with mean thoracic diameter reduction of 4.29 mm and 14.65% false lumen thrombosis.

Conclusions:

• TEVAR in hrTBAD patients demonstrates low early mortality, favorable long-term survival, and encouraging aortic remodeling, particularly in the subacute phase.
• Current evidence stems from non-randomized studies, necessitating further prospective trials for refined patient selection and long-term efficacy confirmation.
• TEVAR should be considered judiciously on a case-by-case basis, integrating risk profiles and multidisciplinary assessment until randomized evidence is available.