Comparison of percutaneous vs. cutdown access for endovascular aortic repair in the treatment of type B aortic dissection: a meta-analysis.

INTRODUCTION

This meta-analysis was designed to compare the safety and efficacy of percutaneous endovascular aortic repair (PEVAR) with endovascular aortic repair by cutdown access (CEVAR) in the treatment of TBAD.

MATERIALS AND

METHODS

Four databases (PubMed, Embase, Web of Science, and Cochrane Library) were carefully queried for articles comparing PEVAR and CEVAR in patients with TBAD. The search was performed from the foundation of the databases until March 31, 2025.

RESULTS

Totally 24 studies were included in this meta-analysis. The meta-analysis included a group of 28,263 patients diagnosed with TBAD, with 14,534 patients undergoing PEVAR and 13,729 patients undergoing CEVAR. In comparison to CEVAR, PEVAR resulted in a reduced hospital length of stay (MD = -2.16 days, 95% CI: -3.05 to -1.27, P < 0.00001), decreased operative time (MD = -40.87 min, 95% CI: -49.72 to -32.02, P < 0.00001), shorter postoperative duration (MD = -1.01 days, 95% CI: -1.56 to -0.45, P = 0.0004), diminished incidence of groin infection (OR = 0.44, 95% CI: 0.30 to 0.65, P < 0.0001), lower occurrence of heart-related complications (OR = 0.76, 95% CI: 0.59 to 1.00, P = 0.05), and reduced incidence of lymphocele (OR = 0.49, 95% CI: 0.24 to 0.98, P = 0.04), but a higher incidence of surgical suture failure (OR = 2.61, 95% CI: 1.52 to 4.50, P = 0.0005) and pseudoaneurysm (OR = 2.64, 95% CI: 1.09 to 6.41, P = 0.03). No statistically significant differences were observed between the two groups concerning estimated blood loss, ICU admissions, hematoma, acute kidney injury, lower extremity revascularization, ischemic colitis, and deep venous thrombosis.

CONCLUSIONS

Compared to CEVAR, PEVAR was associated with a shorter hospital stay, reduced operative time, quicker postoperative recovery, lower rates of groin infections, fewer cardiac complications, and a diminished occurrence of lymphocele; however, it exhibited a higher incidence of pseudoaneurysm and an increased rate of surgical suture failure. PEVAR was a safe and effective method for the treatment of TBAD.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420251110307, PROSPERO CRD420251110307.