Evolution of lesion-specific management of blunt thoracic aortic injury

Abstract

Developments in diagnosis and treatment have transformed the management of blunt thoracic aortic injuries (BTAIs). For patients in stable condition, treatment practice has shifted from early open repair to nonoperative management for low-grade lesions and routine delayed endovascular repair for more significant injuries. However, effective therapy depends on accurate staging of injury grade and stability to select patients for appropriate management. Recent developments in BTAI risk stratification enable lesion-specific management tailored to the patient and aortic lesion. This review summarizes advances in lesion assessment and treatment and proposes an integrated scheme for the modern management of BTAI.

Determinants and outcomes of nonoperative management for blunt traumatic aortic injuries

“…For lesions that persist, routine followup imaging before hospital discharge and at 1 month, 6 months, 12 months, and then annually appears reasonable. 9,12,19 Limitations. Our single-center study has important limitations that must be acknowledged.…”

Thoracic Trauma

“…If initial management is nonoperative, follow-up CT imaging is necessary. Exact timing of follow-up is not well established, but a reasonable approach would be a repeat CT in 36-72 h and then again in several weeks if stable [13]. A minority of these injuries demonstrate progression on follow-up CT imaging, at which time endovascular stenting can be performed if necessary.…”

Thoracic Endovascular Repair for Acute Traumatic Transection of the Descending Thoracic Aorta and Postendovascular Remodeling Change

“…Traumatic transection of the thoracic aorta (TTA) is a lifethreating emergency in blunt thoracic injury and the second most common cause of death after a head trauma. [1][2][3][4] TTA is associated with accidents that involve sudden deceleration, such as that experienced in a car crash, and is usually located in the aortic isthmus. 2 Computed tomography (CT) enables the rapid screening and diagnosis of TTA, and technical improvements have allowed the visualization of the various features of TTA, thus aiding in treatment decision making.…”

“…2 Computed tomography (CT) enables the rapid screening and diagnosis of TTA, and technical improvements have allowed the visualization of the various features of TTA, thus aiding in treatment decision making. [2][3][4][5][6][7] Surgical treatment is absolutely recommended for grade IV lesions (rupture), according to the guidelines issued by the Society for Vascular Surgery, although there is some controversy about grade III aortic pseudoaneurysms. 4,[6][7][8] Traditional surgical treatment involves replacing the aortic lesion with an artificial graft under cardiopulmonary bypass; however, this method has been reported to result in operative mortality and paraplegia rates of 20% to 30% and 9%, respectively.…”