A systematic review and meta-analysis of endovascular versus open surgical repair for the traumatic ruptured thoracic aorta

Abstract

Objective: The purpose of this study was to compare clinical outcomes between open repair and thoracic endovascular aortic repair (TEVAR) in traumatic ruptured thoracic aorta. Methods: A comprehensive search was undertaken of the four major databases (PubMed, Embase, Scopus, and Ovid) to identify all published data comparing open vs endovascular repair. Databases were evaluated to July 2018. Odds ratios (ORs), weighted mean differences, or standardized mean differences and their 95% confidence intervals (CIs) were analyzed. The primary outcomes were stroke, paraplegia, and 30-day mortality rates; secondary outcomes were requirement for reintervention and 1-year and five-year mortality rates. Results: A total of 1968 patients were analyzed in 21 articles. TEVAR was performed in 29% (n ¼ 578) and open repair in 71% (n ¼ 1390). TEVAR and open repair did not differ in the mean age of patients (42.1 6 14 years vs 44.1 6 14 years; P ¼ .48). There was no difference in duration of intensive care and total hospital stay between TEVAR and open repair groups (12.7 6 11.1 days vs 12.6 6 8 days [P ¼ .35] and 27.5 6 14.6 days vs 25.9 6 11 days [P ¼ .80], respectively). Similarly, no statistically significant difference in postoperative paraplegia or stroke rate was noted between TEVAR and open repair (1.4% vs 2.3% [OR, 1.27; 95% CI, 0.59-2.70; P ¼ .54] and 1% vs 0.5% [OR, 0.63; 95% CI, 0.18-2.18; P ¼ .46]). Lower 30-day and 1-year mortality was noted in TEVAR (7.9% vs 20% [OR, 2.94; 95% CI, 1.92-4.49; P < .00001] and 8.7% vs 17% [OR, 2.11; 95% CI, 0.99-4.52; P ¼ .05]). There was no difference in 5-year mortality (23% vs 17%; OR, 0.07; 95% CI, À0.07 to 0.20; P ¼ .33). However, there was a higher rate of reintervention at 1 year in the endovascular group (0% vs 6%; OR, 0.17; 95% CI, 0.03-0.96; P ¼ .04). Conclusions: TEVAR carries lower in-hospital mortality and provides satisfactory perioperative outcomes compared with open repair in traumatic ruptured thoracic aorta. It also provides a favorable 1-year survival at the expense of higher reintervention rates.

Endovascular repair of traumatic aortic dissection: a single-center experience

“…EVAR has been the first-line treatment for TAI according to the guidelines of the Society for Vascular Surgery (SVS) [2], the European Society of Cardiology [9], the Eastern Association for the Surgery of Trauma [10], and the European Society for Vascular Surgery (ESVS) [1], considering previously published reports of the low mortality and morbidity of EVAR compared with open surgery. Several studies including a relatively large number of cases with a long follow-up showed satisfactory outcomes of EVAR for TAI and superiority of EVAR over open surgery [3,5,6,[11][12][13]. However, EVAR for TAD was scarcely reported, and the characteristics of TAD were not thoroughly known.…”

“…Endovascular aortic repair (EVAR) offers lower perioperative mortality and provides satisfactory outcomes compared with open repair in patients with TAI [5,6]. It has been recommended as the first-line treatment by the 2011 Society for Vascular Surgery clinical practice guidelines and the 2017 European Society for Vascular Surgery Guidelines [1,2].…”

STABILISE; treatment of aortic dissection, a single Centre experience

“…Endovascular repair provides benefit as it avoids major surgical incisions, aortic cross-clamping, reduces procedural time, decreases blood loss, and decreases end-organ ischaemia. (Dangas et al, 2012 ; Walsh et al, 2008 ) Reduced post-operative mortality (30 day; 7.9% vs 20% and 1 year; 8.7% vs 17%), in addition to reduced procedural complications, have also been demonstrated in those undergoing TEVAR compared with open repair (Harky et al, 2020 ; Hsieh et al, 2019 ). Despite these benefits, meta-analyses have shown TEVAR to be associated with pooled reintervention rates of 15%; reasons including, endoleak (33.2%), false-lumen perfusion and aortic dilation (19.8%), and new dissection (6.9%).…”

Blunt Traumatic Aortic Injury Management, a French TraumaBase Analytic Cohort

“…6 The literature regarding this topic is incomplete and outdated. 7 Available studies were mainly performed in countries with different emergency medical systems from those in Europe. Only one large retrospective study has been performed in Europe (Germany), where pre-hospital care might include a physician on site.…”