Pang Dominic, Hildebrand Diane, Bachoo Paul
NHS Grampian, Foresterhill Road, Aberdeen, UK, AB25 2ZN.
Cochrane Database Syst Rev. 2015 Sep 25(9):CD006642. doi: 10.1002/14651858.CD006642.pub2.
Blunt traumatic thoracic aortic injury (BTAI) is a life-threatening surgical emergency associated with mortality up to 8000 per year, most commonly caused by rapid acceleration/deceleration injury sustained through motor vehicle accident and/or blunt thoracic trauma. BTAI has high pre-hospital mortality following the primary injury, with only 10% to 15% of patients surviving long enough to reach the hospital. Open surgical repair had remained the standard treatment option for BTAI since successfully introduced in 1959. However, with technological advances, thoracic endovascular repair (TEVAR) offers an alternative treatment option for BTAI. TEVAR is a less invasive surgical approach for management of these already critical patients; many reports have described favourable early outcomes.Thoracic endovascular repair may appear to be superior to open repair for treatment of BTAI. However, its long-term results and efficacy remain unknown. No randomised controlled trials (RCTs) have provided evidence to support the superiority of the endovascular approach versus open repair in the treatment of BTAI. This review aims to address this matter.
To determine whether use of TEVAR for treatment of BTAI is associated with reduced mortality and morbidity when compared with conventional open surgery.
The Cochrane Vascular Trials Search Co-ordinator searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 7) and clinical trials databases for details of ongoing and unpublished studies.
We considered all published and unpublished randomised controlled trials (RCTs) comparing TEVAR and open surgery for BTAI.
Two review authors independently reviewed all RCTs identified by the Trials Search Co-ordinator.
We found no RCTs that met the inclusion criteria for this review.
AUTHORS' CONCLUSIONS: We found no RCTs conducted to determine whether use of TEVAR for the treatment of BTAI is associated with reduced mortality and morbidity when compared to conventional open repair. Hence, we are unable to provide any evidence to guide the treatment option for this life-threatening condition. To perform a randomised controlled trial to clarify the optimal management of BTAI would be highly challenging due to the natural history of the condition. Despite the lack of RCT evidence, clinicians are moving forward with endovascular treatment of BTAI on the basis of meta-analyses and large clinical series.
钝性创伤性胸主动脉损伤（BTAI）是一种危及生命的外科急症，每年死亡率高达8000例，最常见的原因是机动车事故和/或钝性胸部创伤导致的快速加速/减速损伤。BTAI在初次损伤后有较高的院前死亡率，只有10%至15%的患者存活足够长的时间到达医院。自1959年成功引入以来，开放手术修复一直是BTAI的标准治疗选择。然而，随着技术的进步，胸主动脉腔内修复术（TEVAR）为BTAI提供了另一种治疗选择。TEVAR是一种用于治疗这些病情危急患者的侵入性较小的手术方法；许多报告描述了良好的早期结果。胸主动脉腔内修复术在治疗BTAI方面似乎优于开放修复术。然而，其长期结果和疗效仍然未知。没有随机对照试验（RCT）提供证据支持血管腔内治疗方法优于开放修复术治疗BTAI。本综述旨在解决这一问题。
确定与传统开放手术相比，使用TEVAR治疗BTAI是否能降低死亡率和发病率。
Cochrane血管试验搜索协调员检索了Cochrane对照试验中心注册库（CENTRAL；2015年第7期）和临床试验数据库，以获取正在进行和未发表研究的详细信息。
我们纳入了所有比较TEVAR和开放手术治疗BTAI的已发表和未发表的随机对照试验（RCT）。
两位综述作者独立审查了试验搜索协调员确定的所有RCT。
我们未发现符合本综述纳入标准的RCT。
我们未发现有RCT来确定与传统开放修复相比，使用TEVAR治疗BTAI是否能降低死亡率和发病率。因此，我们无法提供任何证据来指导这种危及生命疾病的治疗选择。由于该疾病的自然病程，进行一项随机对照试验以阐明BTAI的最佳治疗方法具有很大挑战性。尽管缺乏RCT证据，但临床医生基于荟萃分析和大型临床系列研究，正在推进BTAI的血管腔内治疗。
