背景:钝性胸主动脉损伤(BTAI)是血管创伤最具破坏性的情况之一。不同的管理策略可用于不同的临床结果。然而,胸主动脉腔内修复术(TEVAR)已成为大多数BTAI患者的一线选择,主要是由于其微创性质,产生改善的直接结果。这项荟萃分析旨在调查死亡率,长期生存,以及BTAITEVAR后的再干预。
方法:系统综述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。27项研究符合设定的纳入/排除标准。使用综合荟萃分析软件v.4对提取的数据进行比例荟萃分析。
结果:纳入1498例接受TEVAR的BTAI患者。使用SVS分级系统,2.6%的人口有一级伤害,13.6%二级,62.2%级,4级19.6%,非特异性1.9%。在所有研究中,全因死亡率均不超过20%,除了一个异常值,死亡率为37%。使用随机效应模型,总死亡率的汇总估计值为12%(95CI5.35~8.55%;I2=70.6%).在6个月时为91%(95CI,88.6-93.2;I2=30.2%),90.1%(95CI,86.7-92.3;I2=53.6%),89.2%(95CI,85.2-91.8;I2=62.3%),和88.1%(95CI,83.3-90.9;I2=69.6%)。此外,再干预的汇总估计值为6.4%(95CI,0.1~0.49%;I2=81.7%).
结论:尽管与BTAI相关的高发病率和死亡率,TEVAR已被证明是一种安全有效的管理策略,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,并具有适当的分级,并迅速转移到具有适当TEVAR设施的创伤中心。
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.
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%; I2 = 70.6%). This was 91% (95% CI, 88.6-93.2; I2 = 30.2%) at 6 months, 90.1% (95% CI, 86.7-92.3; I2 = 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; I2 = 69.6%) at 5 years. Moreover, the pooled estimate of reintervention was 6.4% (95% CI, 0.1-0.49%; I2 = 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.