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Original Article

Contemporary Management of Blunt Thoracic Aortic Injury

Results of an EAST, AAST and SVS survey by the Aortic Trauma Foundation

  • Erik Scott DeSoucy US Air Force
  • Melissa Loja University of California Davis Medical Center
  • Joseph Dubose University of California Davis Medical Center
  • Anthony Estrera University of Texas Houston Division of Cardiothoracic Surgery
  • Ben Starnes University of Washington Division of Vascular Surgery
  • Ali Azzizadeh University of Texas Houston Division of Vascular Surgery


Objective: To determine contemporary management practices for BTAI among trauma and vascular surgeons.

Methods: A survey of EAST, AAST and SVS membership regarding BTAI care was conducted.

Results: 404 respondents included trauma (52.5%), vascular (42.6%) and other specialty providers (4.5%) primarily from North American (90.6%) academic teaching institutions (71.0%) / ACS Level I trauma centers (58.9%). Most respondents managed 1-5 BTAI annually (71.6%). Preferred diagnostic modality was CTA (99.8%), after which respondents stated they preferred to utilize personal knowledge of the literature and experience (50.5%), the SVS guidelines (27.4%) or institution specific guidelines (12.8%) to guide subsequent management. Respondents primarily agreed on the treatment of intimal tears (SVS G1) with medical management. For intramural hematoma (SVS G2), management choice was divided between medical (46.6%) and TEVAR (46.3%). Both groups defined TEVAR as treatment of choice for hemodynamically stable patients with pseudoanuerysm (SVS G3) (93.5%) and rupture (SVS G4) (82.2%), although more trauma surgeons preferred open repair (20.4%) than vascular counterparts (4.1%) in stable G4 patients. Preferred medical management goals varied between MAP (37.3%) and SBP (62.3%) targets. Preferences also varied in adjuncts for open repair [Left heart bypass 56.5%; Clamp and Sew 46.1%; CSF drainage 48.5%] and TEVAR [percutaneous puncture for arterial access 58.4%; open vascular exposure 65.5%, IVUS 36.1%, CSF drainage 28.9%]. Outpatient follow-up timing (2 weeks 37.0%, 1 month 37.2%) and initial type (clinical exam 36.6%, CTA 48.3%) also varied.

Conclusions: Survey of trauma and vascular surgeons illustrates controversy regarding SVS G2 treatment, surgical adjuncts and follow-up. Additional study is required to identify optimal BTAI management.




How to Cite

DESOUCY, Erik Scott et al. Contemporary Management of Blunt Thoracic Aortic Injury. Journal of Endovascular Resuscitation and Trauma Management, [S.l.], v. 1, n. 1, p. 4-8, aug. 2017. ISSN 2002-7567. Available at: <>. Date accessed: 21 oct. 2018. doi:


Original Article