Endovascular versus medical therapy for uncomplicated type B aortic dissection: a qualitative review.
BACKGROUND
Uncomplicated type B dissections have been traditionally managed with antihypertensive therapy. In the endovascular era, this dictum has been revisited. This review pooled the available studies to compare the outcomes of best medical therapy (BMT) to thoracic endovascular aortic repair (TEVAR) for uncomplicated type B dissections.


METHODS
A literature search was performed to identify studies on uncomplicated type B dissections managed with BMT with and without TEVAR. The primary outcome measures were mortality rates at 30 days and at 2 years following intervention.


RESULTS
A total of 6 studies included 123 patients who underwent TEVAR/BMT, and 566 patients who had BMT alone. The mortality rates at 30 days (6.5% TEVAR/BMT vs 4.8% BMT, P = .21) and at 2 years (9.7% vs 11.9%, P = .32) were similar. Renal failure was greater in TEVAR/BMT (15.4% vs 2.1%, P < .01). Rates of surgical reintervention/intervention were similar (17.6% vs 20.1%, P = .31).


CONCLUSION
The TEVAR with BMT does not provide survival benefit compared to BMT alone, 2 years following uncomplicated type B aortic dissection.
['Merola|Jonathan|J|', 'Garg|Karan|K|', 'Adelman|Mark A|MA|', 'Maldonado|Thomas S|TS|', 'Cayne|Neal S|NS|', 'Mussa|Firas F|FF|']
D000784:Aneurysm, Dissecting D000959:Antihypertensive Agents D017545:Aortic Aneurysm, Thoracic D001019:Aortic Rupture D001027:Aortography D019917:Blood Vessel Prosthesis Implantation D057510:Endovascular Procedures D006801:Humans D051437:Renal Insufficiency D012086:Reoperation D013997:Time Factors D016896:Treatment Outcome
uncomplicated aortic dissection endovascular repair