Thoracic endovascular aortic repair compared with medical treatment in patients with type B intramural hematoma.

Background: The benefit-risk profile of thoracic endovascular aortic repair (TEVAR) in patients with type B aortic intramural hematoma (IMH) has not been well established yet. This study aimed to evaluate the outcomes of TEVAR compared with medical management (MM) in this population. Patients and methods: PubMed, EMBASE, the Cochrane Library, and clinicaltrials.gov were searched to identify studies comparing TEVAR with MM in patients with type B IMH. Results: Sixteen studies involving 1528 patients were included in this meta-analysis. Compared with the MM group, the TEVAR group displayed similar incidences of in-hospital death [RR (95%CI): 0.73 (0.32-1.66), p=.45] and aortic-related death [RR (95%CI): 0.70 (0.31-1.58]), p=.39]. The risk of all-cause death was comparable between the two groups [RR (95%CI): 0.62 (0.36-1.07), p=.08]. Meanwhile, TEVAR was superior to MM in promoting IMH regression [RR (95%CI): 1.51(1.26-1.81), p<.001] and reducing IMH progression [RR (95%CI): 0.15 (0.08-0.29), p<.001], dissection [RR (95%CI): 0.26 (0.12-0.60), p=.002], and secondary intervention [RR (95%CI): 0.22 (0.08-0.60), p=.003]. Conclusions: In patients with type B IMH, the incidences of in-hospital death, aortic-related death and all-cause death during follow-up were comparable between the TEVAR group and the MM group. However, TEVAR was superior to MM in promoting IMH regression and reducing IMH progression, dissection, and secondary intervention. Further randomized controlled trials are needed to clarify the role of TEVAR in this population.