To open or stent type B aortic dissection: umbrella review and meta-analysis

Background Depending on the clinical features, progression of the dissection, hospital settings, and resources, and the patient’s overall condition, Type B aortic dissection (TBAD) could be managed surgically, endovascular, or conservatively. We sought to conduct an umbrella review to comprehensively synthesize the existing evidence comparing open surgical and endovascular repair for TBAD and pooling data from the contemporary systematic reviews. Methods A comprehensive search was conducted through PubMed, Embase, Cochrane Library, and Web of Science to identify systematic reviews and meta-analyses published between January 2014 and February 2025. Studies were included it they compared OSR and EVR in adult patients and reported outcomes such as mortality, operative complications, reinterventions, or comorbidities. The quality was assessed using the AMSTAR 2 tool. Meta-analysis was conducted using a random-effects model to account for between-study heterogeneity. Results The systematic review process resulted in 12 systematic reviews . The pooled OR of 0.39 indicates a 61% reduction in mortality risk with TEVAR. Despite high heterogeneity, the overall trend strongly favors TEVAR. TEVAR significantly reduces early, 1-year, and 3-year mortality compared to OSR, while no survival benefit is observed at 5 years. TEVAR is also associated with lower rates of major complications (Figures 1 and 2). Conclusion This umbrella review highlights the advantages of TEVAR over OSR. However, long-term outcomes between the two approaches remain similar, with no significant difference in 5-year survival rates. Future research, including RCTs and long-term studies, is necessary to define better the role of TEVAR in treating TBAD.