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Background <p>Traumatic axillosubclavian arterial injuries are rare but associated with high morbidity and mortality. Endovascular re<i>p</i>air (ER) has emerged as an alternative to open surgery (OS), yet comparative outcome data remain inconsistent. This systematic review and meta-analysis compared short-term outcomes of ER versus OS for these injuries.</p> Methods <p>This study followed PRISMA guidelines and was registered in PROSPERO (CRD420251018150). PubMed, Embase, Cochrane Library, and Scopus were searched for studies. Eligible studies included adult patients with blunt or penetrating traumatic axillosubclavian arterial injuries treated with ER or OS. The primary outcome was short-term all-cause mortality (in-hospital or 30-day). Secondary outcomes included upper-extremity amputation, thrombosis of repair, and stroke. Pooled odds ratios with 95% confidence intervals (CIs) were calculated using random-effects models. Heterogeneity was assessed using the I² statistic. Risk of bias and certainty of evidence were evaluated using ROBINS-I and GRADE.</p> Results <p>Twelve retrospective observational studies including 2 854 patients were analyzed. OS was associated with higher mortality compared with ER (OR 2.07, 95% CI 1.46–2.93; <i>p</i> &lt; .001). No significant differences were observed for amputation (OR 1.26, 95% CI 0.59–2.73; <i>p</i> = .55), thrombosis of repair (OR 1.05, 95% CI 0.37–2.94; <i>p</i> = .93), or stroke (OR 1.06, 95% CI 0.69–1.63; <i>p</i> = .78). Certainty of evidence was moderate for mortality and very low for secondary outcomes.</p> Conclusion <p>ER is associated with lower short-term mortality compared with OS in patients with traumatic axillosubclavian arterial injuries, with similar rates of amputation, thrombosis, and stroke. These findings are limited by retrospective study designs and potential confounding, highlighting the need for prospective, multicenter studies to validate outcomes and assess long-term durability.</p>

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Comparison of short-term outcomes in open versus endovascular management of traumatic axillosubclavian arterial injuries in the contemporary era: a systematic review and meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月2日

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  • Shang-Yu Tsai,
  • Shao-Kai Sum,
  • Tzu‐Yen Huang,
  • Tzu‐Ping Chen,
  • Shun‐Ying Yin,
  • Yao‐Chang Wang,
  • Chi‐Hsiao Yeh

摘要

Background

Traumatic axillosubclavian arterial injuries are rare but associated with high morbidity and mortality. Endovascular repair (ER) has emerged as an alternative to open surgery (OS), yet comparative outcome data remain inconsistent. This systematic review and meta-analysis compared short-term outcomes of ER versus OS for these injuries.

Methods

This study followed PRISMA guidelines and was registered in PROSPERO (CRD420251018150). PubMed, Embase, Cochrane Library, and Scopus were searched for studies. Eligible studies included adult patients with blunt or penetrating traumatic axillosubclavian arterial injuries treated with ER or OS. The primary outcome was short-term all-cause mortality (in-hospital or 30-day). Secondary outcomes included upper-extremity amputation, thrombosis of repair, and stroke. Pooled odds ratios with 95% confidence intervals (CIs) were calculated using random-effects models. Heterogeneity was assessed using the I² statistic. Risk of bias and certainty of evidence were evaluated using ROBINS-I and GRADE.

Results

Twelve retrospective observational studies including 2 854 patients were analyzed. OS was associated with higher mortality compared with ER (OR 2.07, 95% CI 1.46–2.93; p < .001). No significant differences were observed for amputation (OR 1.26, 95% CI 0.59–2.73; p = .55), thrombosis of repair (OR 1.05, 95% CI 0.37–2.94; p = .93), or stroke (OR 1.06, 95% CI 0.69–1.63; p = .78). Certainty of evidence was moderate for mortality and very low for secondary outcomes.

Conclusion

ER is associated with lower short-term mortality compared with OS in patients with traumatic axillosubclavian arterial injuries, with similar rates of amputation, thrombosis, and stroke. These findings are limited by retrospective study designs and potential confounding, highlighting the need for prospective, multicenter studies to validate outcomes and assess long-term durability.