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Nonoperative management rather than endovascular repair may be safe for grade II blunt traumatic aortic injuries: An 11-year retrospective analysis

Spencer, Stephen, M., MD; Safcsak, Karen; Smith, Chadwick, P., MD; Cheatham, Michael, L., MD; Bhullar, Indermeet, S., MD

Journal of Trauma and Acute Care Surgery: January 2018 - Volume 84 - Issue 1 - p 133–138
doi: 10.1097/TA.0000000000001630
Original Articles

BACKGROUND The Society of Vascular Surgery (SVS) guidelines currently suggest thoracic endovascular aortic repair (TEVAR) for grade II–IV and nonoperative management (NOM) for grade I blunt traumatic aortic injury (BTAI). However, there is increasing evidence that grade II may also be observed safely. The purpose of this study was to compare the outcome of TEVAR and NOM for grade I–IV BTAI and determine if grade II can be safely observed with NOM.

METHODS The records of patients with BTAI from 2004 to 2015 at a Level I trauma center were retrospectively reviewed. Patients were separated into two groups: TEVAR versus NOM. All BTAIs were graded according to the SVS guidelines. Minimal aortic injury (MAI) was defined as BTAI grade I and II. Failure of NOM was defined as aortic rupture after admission or progression on subsequent computed tomography (CT) imaging requiring TEVAR or open thoracotomy repair (OTR). Statistical analysis was performed using Mann–Whitney U and χ2 tests.

RESULTS A total of 105 adult patients (≥16 years) with BTAI were identified over the 11-year period. Of these, 17 patients who died soon after arrival and 17 who underwent OTR were excluded. Of the remaining 71 patients, 30 had MAI (14 TEVAR vs. 16 NOM). There were no failures in either group. No patients with MAI in either group died from complications of aortic lesions. Follow-up CT imaging was performed on all MAI patients. Follow-up CT scans for all TEVAR patients showed stable stents with no leak. Follow-up CT in the NOM group showed progression in two patients neither required subsequent OTR or TEVAR.

CONCLUSIONS Although the SVS guidelines suggest TEVAR for grade II–IV and NOM for grade I BTAI, NOM may be safely used in grade II BTAI.

LEVEL OF EVIDENCE Therapeutic study, level IV.

From the Orlando Regional Medical Center (S.M.S., C.P.S., I.S.B., K.S.), Orlando, Florida; and Orlando Health Surgical Group (M.L.C.), Orlando Regional Medical Center, Orlando, Florida.

Submitted: March 6, 2017, Revised: May 17, 2017, Accepted: May 29, 2017, Published online: June 20, 2017.

The study was presented at the 75th annual meeting of the American Association for the Surgery of Trauma, September 14–17, 2016, in Waikoloa, Hawaii.

Address for reprints: Indermeet S. Bhullar, MD, Orlando Regional Medical Center, 86 West Underwood Street, Suite 201 Orlando, FL 32806; email:

© 2018 Lippincott Williams & Wilkins, Inc.