Introduction: to investigate the long-term reinterventions of thoracic endovascular repair (TEVAR) after blunt traumatic aortic injury (BTAI). Methods: MEDLINE, EMBASE, and Cochrane databases were interrogated until June 2021. Inclusion criteria: BTAI treated with TEVAR and mean follow-up >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-and-eight patients were collected and 389 surviving >30 days were included. The mean follow-up was 8.2 years (95%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-day 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 2/389, 1/389, and 0/389 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.
Gennai, S., Leone, N., Mezzetto, L., Veraldi, G.F., Santi, D., Spaggiari, G., et al. (2023). Systematic Review and Meta-analysis of Long-term Reintervention Following Thoracic Endovascular Repair for Blunt Traumatic Aortic Injury. JOURNAL OF VASCULAR SURGERY, Online ahead of print, Online ahead of print-Online ahead of print [10.1016/j.jvs.2023.01.196].
Systematic Review and Meta-analysis of Long-term Reintervention Following Thoracic Endovascular Repair for Blunt Traumatic Aortic Injury
Leone, Nicola
Co-primo
Writing – Original Draft Preparation
;
2023
Abstract
Introduction: to investigate the long-term reinterventions of thoracic endovascular repair (TEVAR) after blunt traumatic aortic injury (BTAI). Methods: MEDLINE, EMBASE, and Cochrane databases were interrogated until June 2021. Inclusion criteria: BTAI treated with TEVAR and mean follow-up >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-and-eight patients were collected and 389 surviving >30 days were included. The mean follow-up was 8.2 years (95%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-day 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 2/389, 1/389, and 0/389 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.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
