Assessing the Safety and Effectiveness of Endovascular Treatment Vs. Surgical Repair of Aortic Aneurysms in Patients with Marfan Syndrome: a Literature Review

Background: This review compares the safety and effectiveness of thoracic endovascular aortic repair (TEVAR) versus open surgical repair in patients with Marfan Syndrome (MFS) and thoracic aortic aneurysms. We assessed differences in mortality, length of hospital stay, renal impairment, and stroke incidence between the two techniques. Currently, open surgical repair is the gold standard treatment. Hypothesis: As the gold standard treatment, we expect open surgical repair to have more favorable outcomes than TEVAR. Methods: A systematic literature search was performed using studies from 2000-2024 across PubMed, Scopus, Embase, Cochrane, and Web of Science. Studies were included if they involved adult MFS patients undergoing open or endovascular aortic repair, and excluded if they involved pediatric populations, lacked MFS-specific data, or were case reports. 30-day post-operative outcomes and narrative synthesis of data were performed. Results: Of 4,160 initial results, 22 studies met the inclusion criteria. TEVAR was associated with reduced in-hospital stay (7–22 days), lower 30-day renal impairment (2.0%), and lower 30-day mortality rate (3.0%) compared to open repair (10–24 days, 9.5% renal impairment, 3.5% mortality rate). TEVAR had a greater 30-day stroke rate (3.5% vs. 1.8%). Conclusions: Overall, TEVAR and open repair are both potential options for patients with MFS, with TEVAR conferring some early post-operative advantages but with concerns of greater stroke risk. Interpretation of the findings was limited by small sample sizes and variation in outcome definition. Future research should prioritize standardized reporting and long-term follow-up in MFS populations to better inform clinical management strategies.