The endovascular repair of blunt traumatic thoracic aortic injury in Asia: A systematic review and meta-analysis

Abstract

Introduction 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. Method 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). Results 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. Conclusion 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.

Tratamento endovascular de dissecção traumática de aorta torácica – série de 16 casos

“…15 Current recommendations in the literature limit maximum oversizing to 20%. 16 The size of the endografts used and their positioning are determinant factors in the post-treatment results. García Reyes et al 15 observed that patients who exhibited complications related to endografts had greater oversizing than a subset free from complications (p = 0.0007).…”

“…15 The majority of devices currently available are not specifically designed for traumatic injuries to the aorta, and it is difficult to find the smaller sizes that would be ideal for younger patients. 16 This obliges many surgeons to implant endografts with greater oversizing, as the only viable option for endovascular treatment. However, excessive oversizing can be related to type I endoleak and kinking and collapse of endografts.…”

Grade four blunt traumatic aortic injury with massive haemothorax: Resuscitation considerations during the primary survey

“…Aortic injuries are associated with mechanisms involving penetrating and blunt trauma. Blunt traumatic aortic injuries (BTAI) of the thoracic aorta account for the second greatest cause of traumatic deaths with a significant impact to function amongst survivors [ [2] , [3] , [4] ]. Injuries occur mainly due to rapid deceleration with high-energy impact to the thorax, often involving motor vehicle and aircraft collisions, assaults, crush injuries and falls from significant heights [ 2 , 3 ].…”

“…Blunt traumatic aortic injuries (BTAI) of the thoracic aorta account for the second greatest cause of traumatic deaths with a significant impact to function amongst survivors [ [2] , [3] , [4] ]. Injuries occur mainly due to rapid deceleration with high-energy impact to the thorax, often involving motor vehicle and aircraft collisions, assaults, crush injuries and falls from significant heights [ 2 , 3 ]. Patients at greater risk of BTAI in vehicle collisions are those aged 60 years or older, unrestrained, or occupants of front seats [ 5 , 6 ].…”

Application of rib surface positioning ruler combined with volumetric CT measurement technique in endoscopic minimally invasive thoracic wall fixation surgery

“…Chest trauma is the second leading cause of trauma-related deaths, accounting for 20-25% of all trauma-related deaths (1). Multiple rib fractures, especially in patients with flail chest, are often accompanied by severe pain, chest wall softening, abnormal breathing and severe lung contusion.…”