AI Article Synopsis

  • * A systematic review analyzed 27 studies involving 1,498 BTAI patients treated with TEVAR, finding an overall mortality rate of 12% and long-term survival rates of around 90% at 1 year post-treatment.
  • * The findings suggest that while BTAI carries significant risks, TEVAR offers a safe and effective management option with a low likelihood of needing additional procedures, emphasizing the importance of timely diagnosis and transfer to trauma centers.

Article Abstract

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 = 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%).

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.

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Source
http://dx.doi.org/10.1016/j.avsg.2024.04.029DOI Listing

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