P165: Thoracic Endovascular Aortic Repair in Traumatic Blunt Thoracic Aortic Injury: A Systematic Review & Meta-analysis

Abstract

Abstract Background Blunt thoracic aortic injury (BTAI) represents one of the most devastating scenarios of vascular trauma. Different management strategies are available with varying clinical outcomes, however, thoracic endovascular aortic repair (TEVAR) has become the first-line option for most BTAI patients, mainly owing to its minimally invasive nature yielding improved immediate results. This meta-analysis aims to investigate mortality and long-term survival as well as reintervention following TEVAR in BTAI. Methods In a systematic review, a comprehensive literature search was conducted on multiple electronic databases using strict search terms. Twenty-five studies met the set inclusion/exclusion criteria. Proportional meta-analysis of extracted data was conducted using the R-studio and STATA software. Results The final analysis included 1367 BTAI patients with who underwent TEVAR. Using the SVS grading system, 2.4% of the population had Grade 1 injuries, 12.8% Grade 2, 60.2% Grade, 22.6% Grade 4, and 1.7% unspecific. All-cause mortality did not exceed 20% in all studies except one outlier with a 37% mortality rate. Using the random-effects model, the pooled estimate of overall mortality was 6.95% (95%CI 5.35-8.55%; I2 = 70.6%). This was 91.2% (95%CI, 88.6-93.2; I2= 30.2%) at 6 months, 89.8% (95%CI, 86.7-92.3; I2 = 53.6%) at 1-year, 88.9% (95%CI, 85.2-91.8; I2= 62.3%) at 2 years, and 87.6% (95%CI, 83.3-90.9; I2 = 69.6%) at 5 years. Moreover, the pooled estimate of reintervention was 0.19% (95%CI, 0.1-0.49%; I2 = 81.7%). Conclusion Despite the high morbidity and mortality associated with BTAI, TEVAR has proven to be a safe and effective management strategy.