Thoracic Endovascular Aortic Repair versus Optimal Medical Treatment in Patients with Type B Intramural Hematoma: A Meta-Analysis

Abstract

Purpose: We intended to study the effect of thoracic endovascular aortic repair (TEVAR) and optimal medical treatment (OMT) on type B intramural hematoma (BIMH). Methods: We searched PubMed, EMbase, Cochrane Library, and China National Knowledge Infrastructure databases that compared TEVAR and OMT in patients with BIMH. Two authors independently assessed the risk of bias using the Newcastle-Ottawa Scale. The rate ratio (RR) and 95% confidence interval were used to calculate the outcome. The primary endpoints were aortic-related death and regression/resolution. Secondary endpoints were all-cause death, progression to dissection, and secondary intervention. Results: Eight observational studies were included in the analysis. TEVAR reduced aorticrelated death (RR 0.22, 95% CI 0.08-0.56, P = 0.002, I² = 24%) and promoted hematoma regression/resolution (RR 1.48, 95% CI 1.05-2.10, P <0.05, I² = 71%) compared to OMT. Moreover, TEVAR was associated with a reduction in progression to dissection (RR 0.32, 95% CI 0.13-0.81, P <0.02, I² = 39%) and secondary intervention (RR 0.18, 95% CI 0.09-0.37, P <0.00001, I² = 38%) compared to OMT. However, all-cause death has no significant difference between the two groups (RR 0.45, 95% CI 0.17-1.19, P = 0.11, I² = 58%). Conclusions: The results of this meta-analysis suggested that TEVAR is an effective treatment for BIMH, which can delay the progression of intramural hematoma and promotes regression/resolution. More research about indications of TEVAR is still needed.

Outcome After Conservative and Endovascular Treatment of Stanford Type B Aortic Intramural Hematomas – A Single-Center Retrospective Study

“…A high proportion of our initially conservatively treated patients showed highrisk features in the follow-up that required treatment by TEVAR, which is an effective treatment and can delay the progression of IMHs and promotes regression. 20 In our cohort, in about 50% of the endovascularly treated patients only spot stenting of an ULP was performed without covering the entire pathology. With both techniques, endovascular therapy led to comparable remodeling of the aorta over time.…”

“…A high proportion of our initially conservatively treated patients showed high-risk features in the follow-up that required treatment by TEVAR, which is an effective treatment and can delay the progression of IMHs and promotes regression. 20 …”