■钝性胸主动脉损伤(BTAI)是一种潜在的危及生命的疾病,目前的指南建议将胸主动脉腔内修复术(TEVAR)作为一线治疗(I级证据C)。本系统评价的目的是确定接受TEVAR治疗的BTAI患者的围手术期和中期随访结果。
■我们回顾了2000年至2022年之间通过Ovid发表的英文文献,使用MEDLINE,EMBASE,和中央数据库,直到2022年7月30日。观察性研究和案例系列,≥5名患者,纳入了接受TEVAR治疗BTAI的患者的围手术期和随访结局的报告.纽卡斯尔-渥太华量表用于评估偏倚风险。主要结果是技术成功和30天死亡率,脑血管发病率。次要结果是中期随访期间的死亡率和再次干预。
■来自文献检索的5201篇文章,35项符合条件的研究纳入本综述。所有研究均采用回顾性研究设计。总的来说,纳入991例患者。平均年龄为34.5±16.5岁(范围=16-89岁)。技术成功率为98.0%(赔率比[OR],95%置信区间[CI]=0.98,0.99,p<0.001,I2=0%)。30天的死亡率为5.0%(OR,95%CI=0.03,0.06,p<0.001,I2=5.56%)。脊髓缺血发生率为1.0%(OR,95%CI=0.01,0.02,p<0.001,I2=0%),卒中发生率为2.0%(OR,95%CI=0.01,0.02,p<0.001,I2=0%)。可用的随访时间估计为29个月(范围=3-119个月),死亡率为2.0%(OR,95%CI=0.01,0.02,p<0.001,I2=0%),再干预率为1.0%(OR,95%CI=0.01,0.02,p<0.001,I2=10.5%)。
■胸主动脉腔内修复术显示出很高的技术成功率和较低的早期脑血管发病率和死亡率。在中期随访中,估计死亡率和再干预率也较低.此外,需要更高质量的前瞻性研究。
结论:建议胸主动脉腔内修复术(TEVAR)作为钝性胸主动脉损伤(BTAI)患者的一线治疗方法。这项对35项回顾性研究和991例患者的系统评价显示,技术成功率很高(98.0%),相关的30天死亡率为5.0%,脊髓缺血(1%)和中风率(2.0%)较低。中期死亡率和再干预率确保了TEVAR在BTAI病例中的有效性。
UNASSIGNED: Blunt thoracic aortic injury (BTAI) represents a potentially life-threatening condition and thoracic endovascular aortic repair (TEVAR) is recommended as the first-line treatment (Class I level of evidence C) by the current guidelines. The aim of this systematic review was to determine the perioperative and mid-term follow-up outcomes of patients with BTAI treated with TEVAR.
UNASSIGNED: We reviewed the English literature published between 2000 and 2022, via Ovid, using MEDLINE, EMBASE, and CENTRAL databases, until July 30, 2022. Observational studies and case series, with ≥5 patients, reporting on the perioperative and follow-up outcomes of patients who underwent TEVAR for BTAI were included. The Newcastle-Ottawa Scale was used to assess the risk of bias. Primary outcomes were technical success and 30-day mortality, cerebrovascular morbidity. Secondary outcomes were mortality and re-interventions during the mid-term follow-up.
UNASSIGNED: From 5201 articles identified by the literature search, 35 eligible studies were included in this review. All studies had a retrospective study design. In total, 991 patients were included. The mean age was 34.5±16.5 years (range=16-89 years). Technical success was 98.0% (odds ratio [OR], 95% confidence interval [CI]=0.98, 0.99, p<0.001, I2=0%). Mortality at 30 days was 5.0% (OR, 95% CI=0.03, 0.06, p<0.001, I2=5.56%). Spinal cord ischemia occurred in 1.0% (OR, 95% CI=0.01, 0.02, p<0.001, I2=0%) and stroke rate was 2.0% (OR, 95% CI=0.01, 0.02, p<0.001, I2=0%). The available follow-up was estimated at 29 months (range=3-119 months) with mortality rate at 2.0% (OR, 95% CI=0.01, 0.02, p<0.001, I2=0%) and re-intervention rate at 1.0% (OR, 95% CI=0.01, 0.02, p<0.001, I2=10.5%).
UNASSIGNED: Thoracic endovascular aortic repair showed high technical success and low early cerebrovascular morbidity and mortality rates. In the mid-term follow-up, the estimated mortality and re-intervention rates were also low. Furthermore, higher quality prospective studies are needed.
CONCLUSIONS: Thoracic endovascular aortic repair (TEVAR) is recommended as the first line treatement in patients with
blunt thoracic aortic injuries (BTAI). This systematic review of 35 retrospective studies and 991 patients showed high technical success (98.0%) with an associated 30-day mortality at 5.0% and low spinal cord ischemia (1%) and stroke rates (2.0%). Mid-term mortality and re-intervention rates reassure the effectiveness of TEVAR in BTAI cases.