Open Surgical Versus Endovascular Repair for Type B Aortic Dissection: Umbrella Review and Meta-Analysis

This umbrella review (UR) synthesizes the current evidence comparing thoracic endovascular aortic repair (TEVAR) with open surgical repair (OSR) for the management of type B aortic dissection (TBAD), with a focus on both early and long-term outcomes. A systematic literature search was performed using PubMed, Embase, Cochrane Library, and Web of Science (2014-2025). Eleven systematic reviews met the inclusion criteria. Short-term mortality was lower with TEVAR, ranging from 2% to13.4%, while it was 4.5% to 19% with OSR. The meta-analysis showed a risk ratio (RR) of 0.51 (95% CI: 0.43-0.59; <i>I</i>² = 64.6%) in favor of TEVAR. Long-term survival was comparable. TEVAR was associated with fewer complications, including cardiac events (odds ratio [OR]: 0.42-0.79), pulmonary events (OR: 0.51-0.57), renal failure (OR: 0.53-0.63), and bleeding (OR: 0.24 and RR: 0.44). For stroke, the UR showed mixed results (OR: 0.23-1.11), but the meta-analysis showed a lower risk with TEVAR (RR: 0.67; 95% CI: 0.54-0.82; <i>I</i>² = 8.7%). Paraplegia rates were comparable (RR: 0.88; 95% CI: 0.53-1.47; <i>I</i>² = 22.7%). Despite the observed moderate to high heterogeneity among most studies (<i>I</i>² = 30%-64.6%), the overall trend favored TEVAR in terms of early outcomes. There was a need for further high-quality, longitudinal studies and randomized controlled trials.