TY - JOUR
T1 - Long-term Survival and Reintervention Following Thoracic Endovascular Aortic Repair in Blunt Traumatic Thoracic Aortic Injury: A Systematic Review and Meta-analysis
AU - Jubouri, Matti
AU - Surkhi, Abdelaziz O
AU - Al-Tawil, Mohammed
AU - Geragotellis, Alexander
AU - Abdaljawwad, Tareq Z I
AU - Qudaih, Mohanad
AU - Elrayes, Mohammed I R
AU - Dewi, Madlen
AU - Moothathamby, Thurkga
AU - Hammad, Aya
AU - Mohammed, Idhrees
AU - Awad, Wael I
AU - D'Oria, Mario
AU - Piffaretti, Gabriele
AU - Bailey, Damian M
AU - Williams, Ian M
AU - Bashir, Mohamad
N1 - Copyright © 2024 Elsevier Inc. All rights reserved.
PY - 2024/8/9
Y1 - 2024/8/9
N2 - Background: Blunt thoracic aortic injury (BTAI) represents one of the most devastating scenarios of vascular trauma. Different management strategies are available with varying clinical outcomes. However, thoracic endovascular aortic repair (TEVAR) has become the first-line option for most BTAI patients, mainly owing to its minimally invasive nature, yielding improved immediate results. This meta-analysis aims to investigate mortality, long-term survival, and reintervention following TEVAR in BTAI. Material and Methods: A systematic review conducted a comprehensive literature search on multiple electronic databases using strict search terms. Twenty-seven studies met the set inclusion/exclusion criteria. A proportional meta-analysis of extracted data was conducted using the Comprehensive Meta-Analysis Software, v.4. Results: 1498 BTAI patients who underwent TEVAR were included. Using the SVS grading system, 2.6% of the population had Grade 1 injuries, 13.6% Grade 2, 62.2% Grade 3, 19.6% Grade 4, and 1.9% unspecific. All-cause mortality did not exceed 20% in all studies except one outlier with a 37% mortality rate. Using the random effects model, the pooled estimate of overall mortality was 12% (95% confidence interval [CI], 5.35–8.55%; I
2 = 70.6%). This was 91% (95% CI, 88.6–93.2; I
2 = 30.2%) at 6 months, 90.1% (95% CI, 86.7–92.3; I
2 = 53.6%) at 1 year, 89.2% (95% CI, 85.2–91.8; I2 = 62.3%) at 2 years, and 88.1% (95% CI, 83.3–90.9; I
2 = 69.6%) at 5 years. Moreover, the pooled estimate of reintervention was 6.4% (95% CI, 0.1–0.49%; I
2 = 81.7%). Conclusions: Despite the high morbidity and mortality associated with BTAI, TEVAR has proven to be a safe and effective management strategy with favorable long-term survival and minimal need for reintervention. Nevertheless, diagnosis of BTAI requires a high index of suspicion with appropriate grading and prompt transfer to trauma centers with appropriate TEVAR facilities.
AB - Background: Blunt thoracic aortic injury (BTAI) represents one of the most devastating scenarios of vascular trauma. Different management strategies are available with varying clinical outcomes. However, thoracic endovascular aortic repair (TEVAR) has become the first-line option for most BTAI patients, mainly owing to its minimally invasive nature, yielding improved immediate results. This meta-analysis aims to investigate mortality, long-term survival, and reintervention following TEVAR in BTAI. Material and Methods: A systematic review conducted a comprehensive literature search on multiple electronic databases using strict search terms. Twenty-seven studies met the set inclusion/exclusion criteria. A proportional meta-analysis of extracted data was conducted using the Comprehensive Meta-Analysis Software, v.4. Results: 1498 BTAI patients who underwent TEVAR were included. Using the SVS grading system, 2.6% of the population had Grade 1 injuries, 13.6% Grade 2, 62.2% Grade 3, 19.6% Grade 4, and 1.9% unspecific. All-cause mortality did not exceed 20% in all studies except one outlier with a 37% mortality rate. Using the random effects model, the pooled estimate of overall mortality was 12% (95% confidence interval [CI], 5.35–8.55%; I
2 = 70.6%). This was 91% (95% CI, 88.6–93.2; I
2 = 30.2%) at 6 months, 90.1% (95% CI, 86.7–92.3; I
2 = 53.6%) at 1 year, 89.2% (95% CI, 85.2–91.8; I2 = 62.3%) at 2 years, and 88.1% (95% CI, 83.3–90.9; I
2 = 69.6%) at 5 years. Moreover, the pooled estimate of reintervention was 6.4% (95% CI, 0.1–0.49%; I
2 = 81.7%). Conclusions: Despite the high morbidity and mortality associated with BTAI, TEVAR has proven to be a safe and effective management strategy with favorable long-term survival and minimal need for reintervention. Nevertheless, diagnosis of BTAI requires a high index of suspicion with appropriate grading and prompt transfer to trauma centers with appropriate TEVAR facilities.
KW - Blunt thoracic aortic injury (BTAI)
KW - endovascular technique
KW - reintervention
KW - survival
KW - thoracic endovascular aortic repair (TEVAR)
KW - trauma
U2 - 10.1016/j.avsg.2024.04.029
DO - 10.1016/j.avsg.2024.04.029
M3 - Review article
C2 - 39004278
SN - 0890-5096
VL - 109
SP - 162
EP - 176
JO - Annals of Vascular Surgery
JF - Annals of Vascular Surgery
IS - 00
ER -