Hull York Medical School, University of York, York, UK.
Faculty of Medicine, Al-Quds University, Jerusalem Palestine.
Ann Vasc Surg. 2024 Dec;109:162-176. doi: 10.1016/j.avsg.2024.04.029. Epub 2024 Jul 14.
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.
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.
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 = 70.6%). This was 91% (95% CI, 88.6-93.2; I = 30.2%) at 6 months, 90.1% (95% CI, 86.7-92.3; I = 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 = 69.6%) at 5 years. Moreover, the pooled estimate of reintervention was 6.4% (95% CI, 0.1-0.49%; I = 81.7%).
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.
钝性胸主动脉损伤（BTAI）是血管创伤中最具破坏性的情况之一。不同的管理策略具有不同的临床结果。然而，胸主动脉腔内修复术（TEVAR）已成为大多数 BTAI 患者的首选治疗方法，主要是由于其微创性质，可带来更好的即时效果。本荟萃分析旨在探讨 BTAI 患者行 TEVAR 后的死亡率、长期生存率和再次干预情况。
系统回顾使用严格的搜索词对多个电子数据库进行了全面的文献检索。符合设定的纳入/排除标准的 27 项研究。使用 Comprehensive Meta-Analysis Software，v.4 对提取的数据进行比例荟萃分析。
纳入了 1498 例接受 TEVAR 的 BTAI 患者。使用 SVS 分级系统，人群中有 2.6%为 1 级损伤，13.6%为 2 级，62.2%为 3 级，19.6%为 4 级，1.9%为非特异性。除了一项死亡率为 37%的异常值外，所有研究的全因死亡率均未超过 20%。使用随机效应模型，总体死亡率的合并估计值为 12%（95%置信区间 [CI]，5.35-8.55%；I=70.6%）。6 个月时为 91%（95% CI，88.6-93.2；I=30.2%），1 年时为 90.1%（95% CI，86.7-92.3；I=53.6%），2 年时为 89.2%（95% CI，85.2-91.8；I2=62.3%），5 年时为 88.1%（95% CI，83.3-90.9；I=69.6%）。此外，再干预的合并估计值为 6.4%（95% CI，0.1-0.49%；I=81.7%）。
尽管 BTAI 相关的发病率和死亡率较高，但 TEVAR 已被证明是一种安全有效的治疗策略，具有良好的长期生存率和最小的再干预需求。然而，BTAI 的诊断需要高度怀疑，并进行适当的分级，并及时转至具有适当 TEVAR 设施的创伤中心。
