Open versus endovascular repair of penetrating non-aortic arterial injuries: A systematic review and meta analysis

Abdul Hafiz Al Tannir; Elise A Biesboer; Courtney Pokrzywa; Simin Golestani; Vasil Kukushliev; Xavier Jean; Eric Harding; Marc A de Moya; Rachel Morris; Nathan Kugler; Morgan Schellenberg; Patrick B Murphy

doi:10.1016/j.injury.2024.111368

Open versus endovascular repair of penetrating non-aortic arterial injuries: A systematic review and meta analysis

Injury. 2024 Mar;55(3):111368. doi: 10.1016/j.injury.2024.111368. Epub 2024 Jan 19.

Affiliations

¹ Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
² Department of Surgery, Division of Vascular & Endovascular Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
³ Department of Surgery, Division of Acute Care Surgery, University of Southern California, Los Angeles, CA, USA.
⁴ Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA. Electronic address: pmurphy@mcw.edu.

PMID: 38309083
DOI: 10.1016/j.injury.2024.111368

Abstract

Background: Non-aortic arterial injuries are common and are associated with high morbidity and mortality. Historically, open surgical repair (OSR) was the conventional method of repair. With recent advancements in minimally invasive techniques, endovascular repair (ER) has gained popularity. We sought to compare outcomes in patients undergoing endovascular and open repairs of traumatic non-aortic penetrating arterial injuries.

Methods: A systematic review and meta-analysis was conducted using MEDLINE (OVID), Web of Science, Cochrane Library, and Scopus Database from January 1st, 1990, to March 20th, 2023. Titles and abstracts were screened, followed by full text review. Articles assessing clinically important outcomes between OSR and ER in penetrating arterial injuries were included. Exclusion criteria included blunt injuries, aortic injuries, pediatric populations, review articles, and non-English articles. Odds ratios (OR) and Cohen's d ratios were used to quantify differences in morbidity and mortality.

Results: A total of 3770 articles were identified, of which 8 met inclusion criteria and were included in the review. The articles comprised a total of 8369 patients of whom 90 % were male with a median age of 28 years. 85 % of patients were treated with OSR while 15 % underwent ER. With regards to injury characteristics, those who underwent ER were less likely to present with concurrent venous injuries (OR: 0.41; 95 %CI: 0.18, 0.94; p = 0.03). Regarding hospital outcomes, patients who underwent ER had a lower likelihood of in-hospital or 30-day mortality (OR: 0.72; 95 %CI: 0.55, 0.95; p = 0.02) and compartment syndrome (OR: 0.29, 95 %CI: 0.12, 0.71; p = 0.007). The overall risk of bias was moderate.

Conclusion: Endovascular repair of non-aortic penetrating arterial injuries is increasingly common, however open repair remains the most common approach. Compared to ER, OSR was associated with higher odds of compartment syndrome and mortality. Further prospective research is warranted to determine the patient populations and injury patterns that most significantly benefit from an endovascular approach.

Level of evidence: Level III, Systematic Reviews & Meta-Analyses.

Keywords: Endovascular repair; Minimally invasive; Non-aortic; Open repair; Penetrating trauma.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Adult
Arteries / surgery
Blood Vessel Prosthesis Implantation* / adverse effects
Child
Compartment Syndromes* / etiology
Endovascular Procedures* / methods
Female
Humans
Male
Odds Ratio
Probability
Risk Factors
Treatment Outcome
Vascular System Injuries* / etiology
Vascular System Injuries* / surgery