Does Endovascular Repair for Blunt Traumatic Aortic Injuries Provide Better Outcomes Compared to Its Open Technique? A Systematic Review and Meta-analysis.
Does Endovascular Repair for Blunt Traumatic Aortic Injuries Provide Better Outcomes Compared to Its Open Technique? A Systematic Review and Meta-analysis.
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DOI：
10.52198/21.sti.39.cv1489
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发表时间：
2021-11-04
影响因子：
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通讯作者：
Latifi, Rifat
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作者：
Gogna, Shekhar;Gachabayov, Mahir;Latifi, Rifat
导言：创伤性主动脉损伤是一种毁灭性的事件，在大多数幸存者中具有很高的死亡率和发病率。目的：比较腔内修复术(ER)和开放修复术(OR)治疗外伤性主动脉损伤的疗效。术后死亡率是主要终点。次要终点包括重症监护病房(ICU)住院时间、住院时间、手术时间、截瘫、中风、急性肾功能衰竭和再手术率。采用具有优势比和95%可信区间(OR(95%CI))的Mantel-Haenszel方法(随机效应模型)和具有均值差(MD(95%CI))的逆方差方法(MD(95%CI))分别测量连续变量和类别变量的影响。结果：共纳入49项研究，涉及12857名患者。两组术后死亡率差异无统计学意义(p=0.459)。在二次结局中，ER术后截瘫发生率显著降低(p=0.032)。其他次要终点如ICU住院时间(p=0.329)、住院时间(p=0.192)、手术时间(p=0.973)、卒中发生率(p=0.121)、急性肾衰发生率(p=0.928)和再手术率(p=0.643)在两组间无显著差异。
INTRODUCTION: Traumatic aortic injuries are devastating events in terms of high mortality and morbidity in most survivors. We aimed to compare the outcomes of endovascular repair (ER) vs. open repair (OR) in the treatment of traumatic aortic injuries.METHODS: PubMed, Embase, and Cochrane Library were systematically searched. Postoperative mortality was the primary endpoint. Secondary endpoints included intensive care unit (ICU) length of stay, hospital length of stay, operating time, paraplegia, stroke, acute renal failure, and reoperation rate. The Mantel-Haenszel method (random-effects model) with odds ratios and 95% confidence intervals (OR (95% CI)), and the inverse variance method with the mean difference (MD (95% CI)), were used to measure the effects of continuous and categorical variables, respectively.RESULTS: A total of 49 studies involving 12,857 patients were included. Postoperative mortality was not significantly different between the two groups (p=0.459). Among secondary outcomes, the paraplegia rate was significantly lower after ER (p=0.032). Other secondary endpoints such as ICU length of stay (p=0.329), hospital length of stay (p=0.192), operating time (p=0.973), stroke rate (p=0.121), ARF rate (p=0.928), and reoperation rate (p=0.643) did not significantly differ between the two groups.CONCLUSION: This meta-analysis found that ER was associated with a reduced paraplegia rate compared to OR for the management of traumatic aortic injury.