Reduced mortality, paraplegia, and stroke with stent graft repair of blunt aortic transections: a modern meta-analysis

J Vasc Surg. 2008 Mar;47(3):671-5. doi: 10.1016/j.jvs.2007.08.031. Epub 2007 Nov 5.

Abstract

Objective: Stent grafting has become the first-line approach to traumatic thoracic aortic transections (TTAT) in some trauma centers due to a perceived decrease in morbidity and mortality compared with standard open repair. We reviewed contemporary outcomes of patients undergoing endovascular repair of TTAT (endoTTAT) and those undergoing open repair (openTTAT) to determine if current reported results support first-line use of endoTTAT.

Method: Retrospective, nonrandomized studies published in English (>5 cases/report) involving TTAT listed in PubMed between 2001 and 2006 were systematically reviewed. Periprocedural outcomes between endoTTAT and openTTAT were analyzed. Mean follow-up was 22.9 months for endoTTAT (reported for 22 of 28 studies) and 48.6 months for openTTAT (reported for 5 of 12 studies). For statistical analysis, t tests were used.

Results: We analyzed 33 articles reporting 699 procedures in which 370 patients treated with endoTTAT and 329 patients managed with openTTAT. No statistical differences were found between patient groups in mean age (41.3 vs 38.8 years, P < .10), injury severity score (39.8 vs 36.0, P < .10), or technical success rates of the procedure (96.5% vs 98.5%, P = .58). In contrast, mortality was significantly lower in the endoTTAT group (7.6% vs 15.2%, P = .0076) as were rates of paraplegia (0% vs 5.6%, P < .0001) and stroke (0.85% vs 5.3%, P = .0028). The most common procedure-related complications for each technique were iliac artery injury during endoTTAT and recurrent laryngeal nerve injury after openTTAT.

Conclusions: To our knowledge, no large multicenter prospective randomized trial comparing endoTTAT and openTTAT has been published in the literature. This meta-analysis of pooled data serves as a surrogate, demonstrating a significant reduction in mortality, paraplegia, and stroke rates in patients who undergo endoTTAT; however, the long-term durability of endoTTAT remains in question.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Adult
  • Aneurysm, Dissecting / etiology
  • Aneurysm, Dissecting / mortality
  • Aneurysm, Dissecting / surgery*
  • Aorta, Thoracic / injuries
  • Aorta, Thoracic / surgery*
  • Aortic Aneurysm, Thoracic / etiology
  • Aortic Aneurysm, Thoracic / mortality
  • Aortic Aneurysm, Thoracic / surgery*
  • Blood Vessel Prosthesis Implantation / adverse effects*
  • Blood Vessel Prosthesis Implantation / instrumentation
  • Blood Vessel Prosthesis*
  • Humans
  • Iliac Artery / injuries
  • Middle Aged
  • Paraplegia / etiology*
  • Paraplegia / mortality
  • Patient Selection
  • Recurrent Laryngeal Nerve Injuries
  • Stents*
  • Stroke / etiology*
  • Stroke / mortality
  • Time Factors
  • Treatment Outcome
  • Wounds, Nonpenetrating / complications*
  • Wounds, Nonpenetrating / mortality
  • Wounds, Nonpenetrating / surgery