Thoracic Endovascular Aortic Repair (TEVAR) versus Best Medical Treatment (BMT) for high-risk type B intramural hematoma (IMH) : A Systematic Review of Clinical Studies.

BACKGROUND: To date , thoracic endovascular aortic repair (TEVAR) for type B aortic dissection is favorable, but TEVAR for type B IMH remains uncertain. There are numerous clinical (eg, refractory pain) and radiologic (eg, IMH thickness) factors that are reported to be associated with IMH progression, challenging the treatment for high-risk type B IMH with high risk factors in clinical practice. OBJECTIVE: To perform a systematic review of clinical studies to investigate outcomes of TEVAR+BMT and BMT in the treatment of high-risk type B IMH . METHODS: The online databases of PubMed, MEDLINE, EMBASE, CNKI, Google Scholar, and Cochrane as well as some journals majoring in endovascular surgery, and interventional therapy were searched on september 1, 2017 . Observational studies that reported the effect of TEVAR and BMT on type B IMH were included . Two independent reviewers performed methodological assessment and data extraction. Random and fixed effects models were used to calculate pooled effect size estimates. A sensitivity analysis was also carried out. RESULTS: In all six included studies, the total number of type B IMH was 237 and 123 received TEVAR+BMT . There was a significantly higher IMH regression rate among patients undergoing TEVAR+BMT compared with BMT (OR 10.0, 95% CI 3.43-29.4). There were a significantly lower IMH progress rate and aortic-related death rate among patients undergoing TEVAR+BMT compared with BMT (OR 0.239, 95% CI 0.075-0.758; OR 0.248, 95% CI 0.085-0.725) . When the study of Ye K et al. was excluded , the results showed no statistically significant. CONCLUSIONS: Combined data from the current study demonstrate that TEVAR+BMT results in significantly higher IMH regression rate , lower IMH progression and lower aortic-related death rate compared with BMT in high-risk type B IMH patients .