Ho Xin Nee, Wee Ian Jy, Syn Nicholas, Harrison Michael, Wilson Lauren, Choong Andrew Mtl
1 SingVaSC, Singapore Vascular Collaborative, Singapore.
2 Division of Vascular Surgery, National University Heart Centre, Singapore.
Vascular. 2019 Apr;27(2):213-223. doi: 10.1177/1708538119828887. Epub 2019 Feb 10.
Blunt traumatic thoracic aortic injury, the second leading cause of death from trauma, poses unique challenges in its management. However, there has not yet been a corresponding consolidated series of outcomes reported in Asia, which this systematic review aims to address.
This review was performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Searches were performed on MEDLINE, EMBASE, Google Scholar, and Cochrane Database for studies performed in Asia reporting the endovascular management of blunt traumatic thoracic aortic injury. Risk of bias was assessed using the Newcastle-Ottawa scale. Meta-analyses of pooled proportions were performed using the metaprop command in STATA. This review has been prospectively registered in PROSPERO (CRD42018083773).
Sixteen retrospective cohort studies were included, reporting a total of 238 patients. The pooled Injury Severity Score was 32.5 (95%CI 27.8-37.1). The pooled mean time to operation from diagnosis was 39.2 hours (95%CI 24.6-53.8 hours), and operation time was 100 min (95%CI 63.5-136.5 min). The pooled rate of procedural conversion from endovascular repair to open surgery was 0.17% (95%CI 0-3.7%), and the proportion of left subclavian artery coverage was 55% (95%CI 37-72%). The pooled prevalence of intra-operative all-cause and aortic-related mortality was 0.72% (95%CI 0-4.9%) and 0.27% (95%CI 0-3.8%), respectively. The pooled prevalence of 30-day all-cause and aortic-related mortality was 2.2% (95%CI 0.16-5.6%) and 2.1% (95%CI 0-3.7%), respectively. In terms of 30-day complication, the pooled prevalence rates of type 1 endoleak, endograft complications, vascular access injury, strokes, and aortic re-rupture were 1.2%, 0.34%, 0.14%, 0.02%, and 0.01%, respectively. There were no cases of types II and III endoleak, and renal failure.
Short- to mid-term results for thoracic endovascular aortic repair for blunt traumatic thoracic aortic injury in Asia are encouraging. However, there is a distinct disparity in reporting across Asia. We propose a prospective database for outcome reporting post thoracic endovascular aortic repair in this patient population, and ongoing follow up to assess long-term efficacy of this treatment strategy.
钝性创伤性胸主动脉损伤是创伤致死的第二大原因，其治疗面临独特挑战。然而，亚洲尚未有相应的关于治疗结果的综合系列报道，本系统评价旨在解决这一问题。
本评价按照系统评价和Meta分析的首选报告项目指南进行。在MEDLINE、EMBASE、谷歌学术和Cochrane数据库中检索在亚洲进行的关于钝性创伤性胸主动脉损伤血管内治疗的研究。使用纽卡斯尔-渥太华量表评估偏倚风险。使用STATA中的metaprop命令对合并比例进行Meta分析。本评价已在PROSPERO（CRD42018083773）中进行前瞻性注册。
纳入16项回顾性队列研究，共报告238例患者。合并损伤严重程度评分为32.5（95%CI 27.8 - 37.1）。从诊断到手术的合并平均时间为39.2小时（95%CI 24.6 - 53.8小时），手术时间为100分钟（95%CI 63.5 - 136.5分钟）。血管内修复转为开放手术的合并比例为0.17%（95%CI 0 - 3.7%），左锁骨下动脉覆盖比例为55%（95%CI 37 - 72%）。术中全因死亡率和主动脉相关死亡率的合并患病率分别为0.72%（95%CI 0 - 4.9%）和0.27%（95%CI 0 - 3.8%）。30天全因死亡率和主动脉相关死亡率的合并患病率分别为2.2%（95%CI 0.16 - 5.6%）和2.1%（95%CI 0 - 3.7%）。在30天并发症方面，I型内漏、血管内移植物并发症、血管入路损伤、中风和主动脉再破裂的合并患病率分别为1.2%、0.34%、0.14%、0.02%和0.01%。没有II型和III型内漏及肾衰竭病例。
亚洲钝性创伤性胸主动脉损伤的胸主动脉血管内修复的中短期结果令人鼓舞。然而，亚洲各地的报告存在明显差异。我们建议建立一个前瞻性数据库，用于报告该患者群体胸主动脉血管内修复后的结果，并进行持续随访以评估该治疗策略的长期疗效。
