SYSTEMATIC REVIEW article
Front. Cardiovasc. Med.
Sec. Cardiovascular Surgery
Comparison of Percutaneous versus Cutdown Access for Endovascular Aortic Repair in the treatment of type B aortic dissection: A Meta-analysis
Provisionally accepted
Zhongyou LiangZiping HuangMinyao WuLidai LinBinyao ChenShan YinHuaicheng LiJieru Quan
Weiming LiangXiaolong Huang*- Guangxi University of Science and Technology, Liuzhou, China
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Abstract Introduction: This meta-analysis was designed to compare the safety and efficacy of percutaneous endovascular aortic repair (PEVAR) with endovascular aortic repair by cutdown access (CEVAR) in the treatment of TBAD. Materials and methods: Four databases (PubMed, Embase, Web of Science, and Cochrane Library) were carefully queried for articles comparing PEVAR and CEVAR in patients with TBAD. The search was performed from the foundation of the databases until March 31, 2025. Results: Totally 24 studies were included in this meta-analysis. The meta-analysis included a group of 28263 patients diagnosed with TBAD, with 14534 patients undergoing PEVAR and 13729 patients undergoing CEVAR. In comparison to CEVAR, PEVAR resulted in a reduced hospital length of stay (MD = -2.16 days, 95% CI: -3.05 to -1.27, P<0.00001), decreased operative time (MD = -40.87 min, 95% CI: -49.72 to -32.02, P<0.00001), shorter postoperative duration (MD = -1.01 days, 95% CI: -1.56 to -0.45, P=0.0004), diminished incidence of groin infection (OR = 0.44, 95% CI: 0.30 to 0.65, P<0.0001), lower occurrence of heart-related complications (OR = 0.76, 95% CI: 0.59 to 1.00, P=0.05), and reduced incidence of lymphocele (OR = 0.49, 95% CI: 0.24 to 0.98, P=0.04), but a higher incidence of surgical suture failure (OR = 2.61, 95% CI: 1.52 to 4.50, P=0.0005) and pseudoaneurysm (OR = 2.64, 95% CI: 1.09 to 6.41, P=0.03). No statistically significant differences were observed between the two groups concerning estimated blood loss, ICU admissions, hematoma, acute kidney injury, lower extremity revascularization, ischemic colitis, and deep venous thrombosis. Conclusions: Compared to CEVAR, PEVAR was associated with a shorter hospital stay, reduced operative time, quicker postoperative recovery, lower rates of groin infections, fewer cardiac complications, and a diminished occurrence of lymphocele; however, it exhibited a higher incidence of pseudoaneurysm and an increased rate of surgical suture failure. PEVAR was a safe and effective method for the treatment of TBAD. Trial registration PROSPERO(CRD420251110307)
Keywords: aortic dissection, Endovascular aneurysm repair, percutaneous, Cutdown, pseudoaneurysm, Meta-analysis
Received: 26 Jul 2025; Accepted: 12 Nov 2025.
Copyright: © 2025 Liang, Huang, Wu, Lin, Chen, Yin, Li, Quan, Liang and Huang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Xiaolong Huang, xiaolonghuang2024@126.com
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