Citation

Spencer SM, Safcsak K, Smith CP, Cheatham ML, Bhullar IS. J. Trauma Acute Care Surg. 2018; 84(1): 133-138.

Affiliation

PGY-IV Resident, Orlando Regional Medical Center, Orlando, FloridaSurgical Academic Research Manager, Orlando Regional Medical Center, Orlando, FloridaDirector of Surgical Critical Care Fellowship, Orlando Regional Medical Center, Orlando, FloridaChairman, Orlando Health Surgical Group, Chief Surgical Quality officer, Orlando Regional Medical Center, Orlando, FloridaDirector of Acute Care Surgery Fellowship, Orlando Regional Medical Center, Orlando, Florida.

Copyright

(Copyright © 2018, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000001630

PMID

28640779

Abstract

BACKGROUND: The Society of Vascular Surgery (SVS) guidelines currently suggest thoracic endovascular aortic repair (TEVAR) for grade II-IV and non-operative 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 2 groups: TEVAR vs. NOM. All BTAI 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 X tests.

RESULTS: 105 adult patients (≥16 years) with BTAI were identified over the 11 years. Of these, 17 patients that died soon after arrival and 17 that 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 2 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 utilized in grade II BTAI. LEVEL OF EVIDENCE: Therapeutic study, Level III.

Language: en