Management of Blunt Thoracic Aortic Injury

Blunt thoracic aortic injury (BTAI) is a life-threatening injury caused by severe trauma. Because BTAI often occurs alongside other serious injuries, evidence-based treatment is critical.

Le Bonheur Vascular Surgeon Erica Mitchell, MD, co-authored an update on the clinical practice guidelines for the management of BTAI in the Journal of Vascular Surgery. The expert panel addressed when to use nonoperative management (NOM) versus thoracic endovascular aortic repair (TEVAR), timing of intervention, adjunctive therapies and care for patients with associated injuries.

Erica Mitchell, MD

• Grade 1 and 2: NOM with minimal or no routine follow-up imaging for grade 1 and a single follow-up CTA for grade 2
• Grade 3: TEVAR after 24 hours for stabilized grade 3 to allow treatment of associated injuries
• Grade 4: Urgent or emergent repair is recommended for unstable patients
• Decisions about left subclavian artery revascularization, anticoagulation, anti-impulse therapy and TEVAR timing should be individualized based on anatomy, bleeding risk and multidisciplinary input
• In patients with traumatic brain injury and BTAI, the brain injury should be prioritized for grades 1-2, while in grade 3, the decision requires multidisciplinary collaboration

“These guidelines represent a meaningful step forward in standardizing care for a devastating injury while preserving the individualized judgment complex trauma patients require,” said Mitchell.