Evaluating the Clinical Profile of Thoracic Endovascular Aortic Repair in Blunt Thoracic Aortic Injury: A Systematic Review and Meta-analysis

Abstract

Objectives: Blunt thoracic aortic injury (BTAI) is a critical vascular emergency associated with high mortality rates. Thoracic endovascular aortic repair (TEVAR) is the gold-standard treatment for this condition. This meta-analysis seeks to comprehensively evaluate the clinical profile and outcomes associated with TEVAR in managing BTAI.

Methods: A systematic review was undertaken using a rigorous methodology. This involved conducting searches across multiple electronic databases using defined search terms while adhering to stringent pre-established inclusion and exclusion criteria in accordance with the Cochrane Handbook and the PRISMA-2020 guidelines. Proportional meta-analysis was executed using Comprehensive Meta-Analysis software (version 4).

Results: A total of 117 studies comprising 29,972 patients were analyzed. The mean age was 42.3 years, with 74.9% being male. The mean Injury Severity Score (ISS) was 35.9, and the distribution of BTAI SVS grades was as follows: Grade 1 at 8%, Grade 2 at 18.1%, Grade 3 at 62.3%, and Grade 4 at 14.9%. The in-hospital and 30-day mortality rate was reported at an aggregated rate of 6.2%. A meta-regression analysis investigating the relationship between mortality and delayed intervention (>24 hours) demonstrated a significant inverse correlation. The incidence of postoperative stroke and endoleak was aggregated at 3.2% and 3%, respectively. Coverage of the left subclavian artery (LSA) was noted in 37.3% of the patients. A sub-analysis was performed to examine the association between BTAI grade and 30-day mortality, which indicated a weak and non-significant correlation (Regression Coefficient: 0.455, P-value=0.2588). Additionally, a meta-regression assessing the relationship between LSA coverage and left arm symptoms did not yield a significant relationship. However, a significant inverse relationship was identified between LSA coverage and stroke incidence.

Conclusion: The management of BTAI poses significant challenges due to its associated high morbidity and mortality rates. However, TEVAR has emerged as a safe and effective intervention, yielding favourable outcomes for patients. Early diagnosis and timely referral to trauma centres equipped with TEVAR capabilities are essential to enhance survival rates and overall patient prognosis.

Keywords: Blunt thoracic aortic injury (BTAI); clinical outcomes; endovascular; thoracic endovascular aortic repair (TEVAR); trauma.