title: Thoracic endovascular aortic repair or best medical therapy for uncomplicated type B aortic dissection? A meta-analysis.
abstract: BACKGROUND
  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).
  
  
  METHODS
  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).
  
  
  RESULTS
  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.
authors: Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
authors: Jue
authors: J
authors: Yang
authors: Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
authors: Yun
authors: Y
authors: Shi
authors: Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China - jiangjhzhongshan@163.com.
authors: Junhao
authors: J
authors: Jiang
mesh_terms: D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D057510:Endovascular Procedures / Q000009:adverse effects; D006801:Humans; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D013927:Thrombosis / Q000209:etiology; D016896:Treatment Outcome