Endovascular management of Stanford type a dissection or intramural hematoma with a distal primary entry tear.

A systematic review was conducted of all published cases of endovascular repair of retrograde Stanford type A dissection or intramural hematoma to determine mortality of this less invasive approach to treatment. Using the PRISMA guidelines, databases were searched for any of the terms 'dissect$', 'IMH', ('aortic ADJ wall'), 'intramur$', 'intra-mur$' in combination with any of 'stent$', 'perc$', 'endo$', 'TEVAR' in combination with any of ('type ADJ A'), 'ascend$' and 'retro$.' The search retrieved 3131 titles, 280 abstracts, and 108 papers. Of 23 relevant papers selected, mortality data could be extracted from 11 studies, representing 60 patients. Overall in-hospital mortality was 1.8% (95% CI 1.2% to 2.4%). Additional all-cause mortality during follow-up was 5.4% (95% CI 3.5% to 7.2%). The placement of an endoluminal device in the descending thoracic aorta to treat a DeBakey IIId/retrograde type A aortic dissection or intramural hematoma may be a safer procedure in the short to medium term than open surgical replacement of the ascending aorta (with or without the arch). Open surgical repair in these patients may therefore be unjustified.