Treatment Strategies And Outcomes Of Thoracic Aortic Blunt Injuries In Adults: A Systematic Review

Authors

  • Luís Fernandes Angiology and Vascular Surgery Department, Vila Nova de Gaia/Espinho Hospital, Portugal
  • Diogo Silveira Angiology and Vascular Surgery Department, Vila Nova de Gaia/Espinho Hospital, Portugal
  • João Peixoto Angiology and Vascular Surgery Department, Vila Nova de Gaia/Espinho Hospital, Portugal
  • Marta Machado Angiology and Vascular Surgery Department, Vila Nova de Gaia/Espinho Hospital, Portugal
  • Francisco Basílio Angiology and Vascular Surgery Department, Vila Nova de Gaia/Espinho Hospital, Portugal
  • Patrícia Carvalho Angiology and Vascular Surgery Department, Vila Nova de Gaia/Espinho Hospital, Portugal
  • Alexandra Canedo Angiology and Vascular Surgery Department, Vila Nova de Gaia/Espinho Hospital, Portugal

DOI:

https://doi.org/10.48729/pjctvs.402

Abstract

Introduction: Blunt thoracic aortic injuries (BTAI) once had mortality rates up to 32%, but the advent of thoracic endovascular aortic repair (TEVAR) has significantly improved outcomes. However, concerns persist regarding long-term devicerelated complications, device integrity in aging aortas, and the criteria for selecting patients for endovascular repair. We aimed to assess BTAI treatment strategies based on injury grade and their associated outcomes.
Methods: A systematic search of MedLine and Scopus databases was conducted to identify original articles published after 2013, which provided information on injury characteristics, outcomes, secondary effects, and reinterventions following BTAI. We classified aortic injuries following the SVS Clinical Practice Guidelines.
Results: We included 28 studies involving 1888 BTAI patients, including 5 prospective studies. Most patients were under 45 years old (86.4%), and grade III injuries were the most common (901 patients), followed by grades I and II (307 and 291 patients, respectively). TEVAR was performed in 1458 patients, mainly with grade III and IV injuries (1040 patients). Approximately half of the grade I injuries (153 of 307) were treated with TEVAR. Thirty-day mortality rate was 11.2%, primarily due to associated injuries. Aortic-related deaths were reported in 21 studies, with an overall rate of 2.2%, but none occurred beyond the first 30 days. Partial or complete coverage of the left subclavian artery was performed in 522 patients, with 27.9% requiring immediate or delayed revascularization. Aortic reintervention rates were relatively low (3.9%).
Conclusion: TEVAR effectively treats BTAI grades III and IV, with potential benefit for some grade II injuries with more aggressive early intervention. Despite SVS guidelines suggesting conservative management for grade I injuries, there is a substantial rate of intervention with positive outcomes and low mortality. Long-term follow-up data, extending up to almost 20 years, reveal the durability of grafts, aortic remodeling, and minimal reintervention and complications.

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Published

07-07-2024

How to Cite

1.
Fernandes L, Silveira D, Peixoto J, Machado M, Basílio F, Carvalho P, Canedo A. Treatment Strategies And Outcomes Of Thoracic Aortic Blunt Injuries In Adults: A Systematic Review. Rev Port Cir Cardiotorac Vasc [Internet]. 2024 Jul. 7 [cited 2024 Jul. 18];31(2):31-40. Available from: https://pjctvs.com/index.php/journal/article/view/402

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