REVIEW  VASCULAR SECTION 

The Journal of Cardiovascular Surgery 2019 February;60(1):100-10

DOI: 10.23736/S0021-9509.17.09942-6

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Endovascular treatment of traumatic thoracic aortic lesions: a systematic review and meta-analysis

Cornelis P. van der ZEE ¹ ✉, Tryfon VAINAS ², Freek A. van BRUSSEL ³, Ignace F. TIELLIU ¹, Clark J. ZEEBREGTS ¹, Maarten J. van der LAAN ¹

¹ Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; ² University Hospitals of Leicester NHS Trust, Leicester, UK; ³ Department of Surgery, Spaarne Gasthuis, Hoofddorp/Haarlem, The Netherlands

INTRODUCTION: To provide an overview of the experience of endovascular treatment for traumatic thoracic aortic lesions (TTAL). Thoracic aortic injury secondary to high-energy chest trauma constitutes an emergency situation with potentially devastating outcome. In the present time, the majority of patients are treated with thoracic endovascular aortic repair. The aim of this study was to provide a systematic overview of endovascular aortic repair in patients with TTAL with special attention to perioperative mortality, paraplegia, stroke, influence of left subclavian artery (LSA) coverage herein, and long-term stent-related complications.
EVIDENCE ACQUISITION: PubMed and Embase were searched for studies describing endovascular treatment of TTAL in the period between January 1st, 2000 and January 30th, 2016. The methodological quality of articles was assessed using the MINORS score and PRISMA guidelines. Data on early mortality, perioperative complications, and long-term stent-related complications were extracted.
EVIDENCE SYNTHESIS: A total of 2005 reports were screened, and 74 publications were finally included in the analysis describing treatment of 1882 patients. Early mortality rate, paraplegia rate, and stroke rate were 7.5%, 0.4%, and 1.5%, respectively. LSA coverage did not increase the risk of stroke. The severity of injuries had a positive association on early mortality. Late stent related mortality and morbidity were uncommon.
CONCLUSIONS: TTAL can be treated endovascularly with low mortality and (neurological) morbidity. LSA coverage does not increase the risk of neurological complications but is associated with a moderate risk of left arm ischemia. Long-term stent-related complications are rare, but the available data is limited.

KEY WORDS: Thoracic aorta - Meta-analysis - Endovascular procedures