Systematic review and meta-analysis of long-term reintervention following thoracic endovascular repair for blunt traumatic aortic injury

Abstract

Objective: To investigate the long-term reinterventions of thoracic endovascular repair (TEVAR) after blunt traumatic aortic injury.

Methods: MEDLINE, EMBASE, and Cochrane databases were interrogated until June 2021. Inclusion criteria were blunt traumatic aortic injury treated with TEVAR and mean follow-up of more than 60 months. A systematic review was conducted and data were pooled using a random effects model of proportions applying the Freeman-Tukey transformation. Late reintervention was the primary outcome. Secondary outcomes were procedure-related complications (endoleak, in-stent thrombosis, occlusion, infolding/collapse, bird-beak, migration, and left arm claudication), overall and aortic-related mortality, and aortic diameter changes.

Results: Eleven studies with a low quality assessment were included. Four hundred eight patients were collected and the 389 surviving more than 30 days were included. The mean follow-up was 8.2 years (95% confidence interval [CI], 5.7-10.8; I² = 40.2%). Late reintervention was 2.1% (95% CI, 0.6-3.9; I² = 0.0%; 11/389 cases) with 0.1% (95% CI, 0.0-1.2; I² = 0.0%; 3/389) occurring after 5 years. Bird-beak was identified in 38.7% (95% CI, 16.4-63.6; I² = 86.6%). Left arm claudication occurring after 30 days was 3.1% (95% CI, 0.1-8.6; I² = 26.9%; 11/140 cases). In-stent thrombosis was 1.9% (95% CI, 0.1-5.2; I² = 51.8%; 11/389 cases). Endoleak was 0.5% (95% CI, 0.0-1.9; I² = 0.0%; 5/389 cases). Infolding, occlusion, and migration were reported in 2 of 389, 1 of 389, and 0 of 389 patients, respectively. Overall late survival was 95.6% (95% CI, 88.1-99.8; I² = 84.7%; 358/389 patients) and only one patient accounted for aortic related mortality. The increase in proximal and distal aortic diameters was estimated at 2.7 mm (95% CI, 1.2-4.3; I² = 0.0%) and 2.5 mm (95% CI, 1.1-3.9; I² = 0.0%), respectively.

Conclusions: TEVAR demonstrates remarkably good long-term results and reinterventions are rarely required. Aortic reinterventions tend to occur within the first and after the fifth year.

Keywords: Blunt injury; Endovascular technique; Meta-analysis; Reintervention; Systematic reviews; Thoracic aorta.