Endovascular-Based Treatment Compared To Frozen Elephant Trunk For Patients With Non-A Non-B Aortic Dissection: A Systematic Review And Meta-Analysis.

Abstract

Objectives: We performed a systematic review and meta-analysis to compare endovascular-based treatments (EBT) to surgical repair with Frozen Elephant Trunk (FET) in patients with non-A non-B aortic dissection and evaluate which of these approaches yields better outcomes.

Methods: The systematic search was conducted using PubMed, Embase, and Cochrane Central databases up to January 2025. Articles were analysed following the Cochrane Collaboration Handbook and the PRISMA guidelines. The outcomes evaluated were all-cause mortality, 30-day mortality, aortic-related reintervention, length of hospital stay, and adverse aortic-related events. In addition, we performed a meta-regression analysis for all the outcomes to assess for any interaction with the following characteristics: prevalence of hypertension, prevalence of diabetes mellitus, aortic arch diameter, median follow-up period, and proportion of repairs in the acute phase of dissection.

Results: The search yielded 942 results, of which 3 studies met the inclusion criteria. A total of 309 patients were included. No statistical difference was observed regarding all-cause mortality, 30-day mortality, length of hospital stay, and adverse aortic-related events. However, EBT revealed a significant increase in aortic-related reintervention compared to FET (RR 1.93; 95% CI 1.67 - 2.22; p < 0.01; I² = 0%). Prespecified meta-regressions showed no significant interactions.

Conclusion: This meta-analysis reveals that FET has an improved outcome compared to endovascular-based treatments for patients with non-A non-B aortic dissection. Furthermore, a definitive recommendation for either surgery or endovascular therapy can not be made because of the limitations inherent to an analysis of a small population with heterogeneous anatomical presentation.