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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Thoracic endovascular vs open surgical repair in descending thoracic aortic aneurysms: A systematic review and meta-analysis
Muneeb Khawar, Umad Ali, Malik Abdullah Rasheed, Abdul Basit Rasheed, Syed Abdullah Shah, Sarmad Zain, Muneeb Saifullah, Moosa Mubarika, Mirza Muhammad Hadeed Khawar, Talha Iqbal, Shameer Iqbal Ghuman, Ikra Rana, Prutha Pathak
Muneeb Khawar, Umad Ali, Syed Abdullah Shah, Muneeb Saifullah, Talha Iqbal, Shameer Iqbal Ghuman, Department of Medicine, King Edward Medical University, Lahore 54000, Punjab, Pakistan
Malik Abdullah Rasheed, Mirza Muhammad Hadeed Khawar, Department of Medicine, Services Institute of Medical Sciences, Lahore 54000, Punjab, Pakistan
Abdul Basit Rasheed, Department of Surgery, Pakistan Kidney and Liver Institute and Research Centre, Lahore 54000, Punjab, Pakistan
Sarmad Zain, Moosa Mubarika, Department of Medicine, Nishtar Medical University, Multan 66000, Punjab, Pakistan
Ikra Rana, Department of Medicine, International School of Medicine International University of Kyrgyzstan, Bishkek 720074, Kyrgyzstan
Prutha Pathak, Internal Medicine, North Alabama Medical Center, Florence, AL 35630, United States
Author contributions: Khawar M and Ali U conceptualized; Khawar M, Ali U, Shah SA, Zain S, Hadeed Khawar MM, Iqbal T, Ghuman SI, and Rana I performed data collation; Khawar M and Zain S were responsible for the methodology; Ali U, Rasheed MA, Rasheed AB, Saifullah M, and Mubarika M conducted a formal analysis; Khawar M, Ali U, Rasheed MA, and Rasheed AB wrote the original manuscript; Khawar M, Ali U, Rasheed MA, Rasheed AB, Shah SA, Zain S, Saifullah M, Mubarika M, Hadeed Khawar MM, Iqbal T, Ghuman SI, and Rana I wrote, reviewed, and edited; Prutha P conducted the final review; and all authors thoroughly reviewed and endorsed the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Ikra Rana, MD, Department of Medicine, International School of Medicine International University of Kyrgyzstan, 6 Street, Bishkek 720074, Kyrgyzstan.
ikrarana100@gmail.com
Received: June 19, 2025
Revised: July 11, 2025
Accepted: September 12, 2025
Published online: October 26, 2025
Processing time: 127 Days and 15.2 Hours
BACKGROUND
Descending thoracic aortic aneurysms are dangerous and have to be treated quickly. The primary treatment methods are thoracic endovascular aortic repair (TEVAR) and open surgical repair (OSR). The comparative effectiveness and safety of TEVAR and OSR were evaluated in this meta-analysis, focusing on perioperative and long-term outcomes.
AIM
To compare and contrast the efficacy and safety of TEVAR vs OSR in the treatment of descending thoracic aortic aneurysms. This study aims to assess both perioperative and long-term outcomes through a systematic review and meta-analysis.
METHODS
A comprehensive search of PubMed, EMBASE, and Cochrane was conducted from inception to January 2025. Baseline characteristics and outcomes were evaluated. Odds ratios (OR) for dichotomous data and mean differences for continuous data with 95% confidence intervals (CI) were analyzed using random-effects models.
RESULTS
A meta-analysis of 21 studies involving 29465 patients (8261 TEVAR; 21204 OR) showed TEVAR associated with lower operative mortality (OR = 0.60, 95%CI: 0.42-0.85, P = 0.004), shorter intensive care unit (-2.94 days, 95%CI: -4.76 to -1.12, P = 0.002) and hospital stays (-7.35 days, 95%CI: -10.54 to -4.17, P < 0.00001), and reduced rates of paraplegia (OR = 0.44, 95%CI: 0.27-0.73, P = 0.002), spinal ischemia (OR = 0.30, 95%CI: 0.16-0.56, P = 0.0002), renal failure (OR = 0.29, 95%CI: 0.14-0.61, P = 0.001), and wound infections (OR = 0.28, 95%CI: 0.13-0.61, P = 0.001). However, TEVAR had higher rates of vascular complications. No significant differences were noted in 1-year and 5-year mortality rates, the rate of non-elective surgery, neurological complications, or stroke rates.
CONCLUSION
Compared to EVAR, TEVAR revealed lower operative mortality and better perioperative outcomes across all indicators, including hospital and intensive care unit stays, as well as fewer complications, except for those related to vascular problems. Mortality results were also similar in the long run; consequently, more research is required concerning the long-term durability.
Core Tip: Thoracic endovascular aortic repair may be the preferred strategy for many patients, particularly those with significant comorbidities or high surgical risk; treatment decisions should be carefully individualized. A comprehensive assessment of patient-specific factors, including anatomical suitability, overall health status, and institutional expertise, remains critical in determining whether an endovascular or open surgical approach is most appropriate. As technological advances and surgical techniques continue to refine, further studies will be essential in guiding optimal patient selection and improving long-term outcomes for descending thoracic aortic aneurysm repair.
