Thoracic endovascular aortic repair for retrograde type a intramural hematoma or aortic dissection with intimal disruption in the descending aorta: Systematic review and meta-analysis

Background While thoracic endovascular aortic repair (TEVAR) for type B aortic dissection is widely used, its use in cases of type A acute aortic syndrome remains limited. This meta-analysis was conducted to determine the outcomes of TEVAR for retrograde type A intramural hematoma (IMH) and aortic dissection with intimal disruption located in the descending aorta. Methods Systematic searches were conducted up to April 2024. Pooled proportions of perioperative and late outcomes were computed. Additionally, standard mean differences (SMD) with 95% confidence intervals (CI) in aortic dimensions following TEVAR were calculated. Kaplan-Meier curves, derived from individual patient data extracted from the studies, were utilized to elucidate long-term all-cause mortality. Results A systematic review identified 13 non-randomized studies encompassing 288 patients. Pooled proportions revealed short-term mortality at 1%, with incidences of spinal cord injury, stroke, new intimal tear/dissection in the ascending aorta, aortic rupture, necessity for aortic re-intervention, and late mortality each recorded at 1%, 1%, 3%, 1%, 6%, and 7%, respectively. Substantial reductions in the diameters of the ascending aorta, descending aorta, IMH/false lumen of the ascending aorta, and IMH/false lumen of the descending aorta were observed post-TEVAR (SMD [95% CI] = 1.11 [0.82–1.39], 1.02 [0.58–1.47], 3.06 [2.39–3.74], and 2.77 [2.28–3.26], respectively). The anticipated 5-year survival rate stood at 91.1%. Conclusion This meta-analysis suggests TEVAR may offer a viable and safe therapeutic option for retrograde type A acute aortic syndrome. Nevertheless, definitive conclusions are hindered by the scarcity of available data.