Systematic Review and Meta-analysis of Current Literature on Isolated Abdominal Aortic Dissection

Eur J Vasc Endovasc Surg. 2020 Apr;59(4):545-556. doi: 10.1016/j.ejvs.2019.05.013. Epub 2019 Dec 9.


Objective: To present the pooled quantitative evidence of basic profiles, initial treatment strategies, and clinical outcomes in patients with isolated abdominal aortic dissection (IAAD).

Methods: A comprehensive systematic review and meta-analysis was performed of all available studies reporting IAAD, retrieved from the MEDLINE, Embase, and Cochrane Databases. The logistic normal random effect model was fitted using the generalised linear mixed model with random intercepts to calculate the pooled proportion estimates.

Results: Seventeen studies with 482 patients were included in this meta-analysis. Male smokers with hyperlipidaemia and hypertension were the most prominent basic profile. IAADs were predominantly spontaneous and infrarenal, and roughly half were acute and symptomatic. Approximately 67% [95% confidence interval (CI) 42-86%] of patients were managed initially conservatively. In the overall population, the 30 day all cause mortality was 3% (95% CI 1-5%) and the long term mortality during follow up was 8% (95% CI 5-14%). Re-intervention during follow up occurred in 8% (95% CI 5-15%) of patients. In the subgroup analysis, patients with conservative treatment had a 30 day mortality of 1% (95% CI 0-8%), a long term mortality of 5% (95% CI 1-29%), and a re-intervention rate of 18% (95% CI 10-29%). Patients with open surgery had a 30 day mortality of 9% (95% CI 0-82%), a long term mortality of 12% (95% CI 4-31%), and a re-intervention rate of 9% (95% CI 1-44%). Patients with endovascular repair had a 30 day mortality of 2% (95% CI 0-10%), a long term mortality of 5% (95% CI 2-13%), a re-intervention rate of 6% (95% CI 3-13%), and a persistent endoleak rate of 4% (95% CI 2-10%).

Conclusion: Appropriate initial treatment strategies can be used to obtain acceptable clinical outcomes in patients with IAAD. Invasive intervention is necessary if patients match certain indications for intervention. Regular imaging surveillance should be provided for all patients, especially those treated conservatively.

Keywords: Basic profile; Isolated abdominal aorta dissection; Meta-analysis; Outcomes; Treatment.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Aortic Aneurysm, Abdominal / surgery*
  • Aortic Dissection / mortality*
  • Aortic Dissection / surgery*
  • Blood Vessel Prosthesis Implantation / adverse effects
  • Endoleak / etiology
  • Endoleak / surgery
  • Endovascular Procedures* / adverse effects
  • Humans
  • Risk Factors