A meta-analysis of the timing of endovascular repair for blunt thoracic aortic injury: Safety and efficacy of early vs. delayed treatment.

BACKGROUND

Blunt thoracic aortic injury (BTAI) carries a high risk of mortality. Thoracic endovascular aortic repair (TEVAR) is a standard treatment. However, the optimal timing of TEVAR remains debated.

METHODS

Embase, Web of Science, PubMed, Cochrane, and Chinese databases were searched for studies comparing emergency (≤24h, n ​= ​4233) and delayed (>24h, n ​= ​1457) TEVAR. Meta-analyses were conducted using Stata 15.0. Subgroup and sensitivity analyses were performed.

RESULTS

Among 5690 patients (13 studies), emergency TEVAR (n ​= ​4233) showed higher in-hospital mortality (OR ​= ​1.99, 95 %CI 1.53 to 2.58) but shorter hospital stays (SMD ​= ​-0.30, 95 %CI -0.54 to -0.07) compared to delayed group (n ​= ​1457). Stroke risk was comparable (OR ​= ​0.89, 95 ​% CI 0.51 to 1.53). Emergency TEVAR reduced ICU and ventilation durations (P ​< ​0.05).

CONCLUSION

Delayed TEVAR reduces mortality risk, while emergency TEVAR shortens hospitalization without increasing the risk of stroke. Tailored protocols are necessary for patients from different regions. Given insignificant results in the Chinese population, improving multi-center collaboration and guidelines is essential by enhancing resource allocation.