Thoracic endovascular vs open surgical repair in descending thoracic aortic aneurysms: A systematic review and meta-analysis
Year: 2025
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: BACKGROUND Descending thoracic aortic aneurysms are dangerous and have to be treated quickly. The primary treatment methods are thoracic endovascular aortic repair (TEVAR) and open surgical repair (OSR). The comparative effectiveness and safety of TEVAR and OSR were evaluated in this meta-analysis, focusing on perioperative and long-term outcomes. AIM To compare and contrast the efficacy and safety of TEVAR vs OSR in the treatment of descending thoracic aortic aneurysms. This study aims to assess both perioperative and long-term outcomes through a systematic review and meta-analysis. METHODS A comprehensive search of PubMed, EMBASE, and Cochrane was conducted from inception to January 2025. Baseline characteristics and outcomes were evaluated. Odds ratios (OR) for dichotomous data and mean differences for continuous data with 95% confidence intervals (CI) were analyzed using random-effects models. RESULTS A meta-analysis of 21 studies involving 29465 patients (8261 TEVAR; 21204 OR) showed TEVAR associated with lower operative mortality (OR = 0.60, 95%CI: 0.42-0.85, P = 0.004), shorter intensive care unit (-2.94 days, 95%CI: -4.76 to -1.12, P = 0.002) and hospital stays (-7.35 days, 95%CI: -10.54 to -4.17, P < 0.00001), and reduced rates of paraplegia (OR = 0.44, 95%CI: 0.27-0.73, P = 0.002), spinal ischemia (OR = 0.30, 95%CI: 0.16-0.56, P = 0.0002), renal failure (OR = 0.29, 95%CI: 0.14-0.61, P = 0.001), and wound infections (OR = 0.28, 95%CI: 0.13-0.61, P = 0.001). However, TEVAR had higher rates of vascular complications. No significant differences were noted in 1-year and 5-year mortality rates, the rate of non-elective surgery, neurological complications, or stroke rates. CONCLUSION Compared to EVAR, TEVAR revealed lower operative mortality and better perioperative outcomes across all indicators, including hospital and intensive care unit stays, as well as fewer complications, except for those related to vascular problems. Mortality results were also similar in the long run; consequently, more research is required concerning the long-term durability.
Source: World Journal of Cardiology
Authors: Muneeb Khawar, Umad Ali, Malik Abdullah Rasheed, Abdul Basit Rasheed, Syed Abdullah Shah, Sarmad Zain, Muneeb Saifullah, Moosa Mubarika, Mirza Muhammad Hadeed Khawar, Talha Iqbal, Shameer Iqbal Ghuman, Ikra Rana, Prutha Pathak
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4415855256