Thoracic endovascular repair (TEVAR) versus open surgery for blunt traumatic thoracic aortic injury

Abstract

Blunt traumatic thoracic aortic injury (BTAI) is a life-threatening surgical emergency associated withmortality up to 8000 per year,most commonly caused by rapid acceleration/deceleration injury sustained through motor vehicle accident and/or blunt thoracic trauma. BTAI has high pre-hospitalmortality following the primary injury, with only 10%to 15%of patients surviving long enough to reach the hospital. Open surgical repair had remained the standard treatment option for BTAI since successfully introduced in 1959. However, with technological advances, thoracic endovascular repair (TEVAR) offers an alternative treatment option for BTAI. TEVAR is a less invasive surgical approach for management of these already critical patients; many reports have described favourable early outcomes. Thoracic endovascular repairmay appear to be superior to open repair for treatment of BTAI. However, its long-termresults and efficacy remain unknown. No randomised controlled trials (RCTs) have provided evidence to support the superiority of the endovascular approach versus open repair in the treatment of BTAI. This review aims to address this matter. This is an update of a review first published in 2015. Objectives To determine whether use of thoracic endovascular repair (TEVAR) for treatment of blunt traumatic thoracic aortic injury (BTAI) is associated with reduced mortality and morbidity when compared with conventional open surgery. Search methods The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL and AMED databases andWorld Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 20 August 2018. Selection criteria We considered all published and unpublished randomised controlled trials (RCTs) comparing TEVAR and open surgery for BTAI. Data collection and analysis Two review authors independently reviewed all RCTs identified by the Cochrane Vascular Information Specialist. Main results We found no RCTs that met the inclusion criteria for this review.