Outcomes and practice patterns of medical management of blunt thoracic aortic injury from the Aortic Trauma Foundation global registry

Aortic Trauma Foundation Study Group

doi:10.1016/j.jvs.2021.08.084

Outcomes and practice patterns of medical management of blunt thoracic aortic injury from the Aortic Trauma Foundation global registry

Aortic Trauma Foundation Study Group

Division of Vascular Surgery

Resultado de la investigación: Article › revisión exhaustiva

3 Citas (Scopus)

Resumen

Objective: Blunt thoracic aortic injury (BTAI) is the second leading cause of death from blunt trauma. In the present study, we aimed to determine the outcomes of medical management (MM) for BTAI. We hypothesized from the results of several previously reported studies, that patients with a minimal aortic injury (BTAI grades 1 and 2) could safely be treated with definitive MM alone. Methods: The Aortic Trauma Foundation international prospective multicenter registry was used to examine the demographics, injury characteristics, management, and outcomes of patients with BTAI. We analyzed a subset of patients for whom MM was initiated as definitive therapy. Results: From November 2016 to April 2020, 432 patients (median age, 41 years; 76% male; median injury severity score, 34) with BTAI (Society for Vascular Surgery grade 1, 23.6%; grade 2, 14.4%; grade 3, 51.2%; grade 4, 10.9%) were evaluated. Of the 432 patients, 245 (57%) had received MM in the initial period and 114 (26.4%) had received MM as the planned definitive therapy (grade 1, 59.6%; grade 2, 23.7%; grade 3, 15.8%; grade 4, 0.9%). The most common mechanism of BTAI was a motor vehicle collision (60.4%). Hypotension was present on arrival in 74 patients (17.2%). Continuous titratable infusion of antihypertensive medication was used for 49.1%, followed by intermittent bolus administration (29.8%), with beta-blockers (74.6%) the most common agent used. Treatments were targeted to a goal systolic blood pressure for 83.3%, most often to a target goal systolic blood pressure <120 mm Hg (66.3%). The MM goals based on blood pressure control were attained in 64.0% (73 of 114). Twelve patients (10.5%; grade 1, 1; grade 2, 0; grade 3, 10; grade 4, 1) had required subsequent intervention after MM. Eleven patients (9.6%) had undergone thoracic endovascular aortic repair and one (0.9%) had required open repair for a grade 4 injury. The overall in-hospital mortality for patients selected for definitive MM was 7.9%. No aortic-related deaths had occurred in the patients receiving definitive MM. Conclusions: Approximately one in four patients with BTAI will receive MM as definitive therapy. The variation in the pharmacologic therapies used is considerable. MM for patients with minimal aortic injury (BTAI grades 1 and 2) is safe and effective, with a low overall intervention rate and no aortic-related deaths. These findings support the use of definitive MM for grade 2 BTAI.

Idioma original	English (US)
Páginas (desde-hasta)	625-631
Número de páginas	7
Publicación	Journal of vascular surgery
Volumen	75
N.º	2
DOI	https://doi.org/10.1016/j.jvs.2021.08.084
Estado	Published - feb 2022

ASJC Scopus subject areas

Surgery
Cardiology and Cardiovascular Medicine

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10.1016/j.jvs.2021.08.084

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@article{048d75e4b251404698ce0f45c4dc758b,

title = "Outcomes and practice patterns of medical management of blunt thoracic aortic injury from the Aortic Trauma Foundation global registry",

abstract = "Objective: Blunt thoracic aortic injury (BTAI) is the second leading cause of death from blunt trauma. In the present study, we aimed to determine the outcomes of medical management (MM) for BTAI. We hypothesized from the results of several previously reported studies, that patients with a minimal aortic injury (BTAI grades 1 and 2) could safely be treated with definitive MM alone. Methods: The Aortic Trauma Foundation international prospective multicenter registry was used to examine the demographics, injury characteristics, management, and outcomes of patients with BTAI. We analyzed a subset of patients for whom MM was initiated as definitive therapy. Results: From November 2016 to April 2020, 432 patients (median age, 41 years; 76% male; median injury severity score, 34) with BTAI (Society for Vascular Surgery grade 1, 23.6%; grade 2, 14.4%; grade 3, 51.2%; grade 4, 10.9%) were evaluated. Of the 432 patients, 245 (57%) had received MM in the initial period and 114 (26.4%) had received MM as the planned definitive therapy (grade 1, 59.6%; grade 2, 23.7%; grade 3, 15.8%; grade 4, 0.9%). The most common mechanism of BTAI was a motor vehicle collision (60.4%). Hypotension was present on arrival in 74 patients (17.2%). Continuous titratable infusion of antihypertensive medication was used for 49.1%, followed by intermittent bolus administration (29.8%), with beta-blockers (74.6%) the most common agent used. Treatments were targeted to a goal systolic blood pressure for 83.3%, most often to a target goal systolic blood pressure <120 mm Hg (66.3%). The MM goals based on blood pressure control were attained in 64.0% (73 of 114). Twelve patients (10.5%; grade 1, 1; grade 2, 0; grade 3, 10; grade 4, 1) had required subsequent intervention after MM. Eleven patients (9.6%) had undergone thoracic endovascular aortic repair and one (0.9%) had required open repair for a grade 4 injury. The overall in-hospital mortality for patients selected for definitive MM was 7.9%. No aortic-related deaths had occurred in the patients receiving definitive MM. Conclusions: Approximately one in four patients with BTAI will receive MM as definitive therapy. The variation in the pharmacologic therapies used is considerable. MM for patients with minimal aortic injury (BTAI grades 1 and 2) is safe and effective, with a low overall intervention rate and no aortic-related deaths. These findings support the use of definitive MM for grade 2 BTAI.",

keywords = "BTAI, Blunt thoracic aortic injury, Medical management, TEVAR, Thoracic endovascular aortic repair, Vascular injury",

author = "{Aortic Trauma Foundation Study Group} and Arbabi, {Cassra N.} and Joseph DuBose and Kristofer Charlton-Ouw and Starnes, {Benjamin W.} and Naveed Saqib and Elina Quiroga and Charles Miller and Ali Azizzadeh and Rana Afifi and Michelle McNutt and Zain Al-Rustum and Binod Shrestha and Edmundo Dipasupil and Ben Starnes and Rami Gilani and David Turay and Xian Luo-Owen and Tiffany Bee and Suzanne Moyer and Joe DuBose and William Shutze and William Dockery and Laura Petrey and Phelps, {Timothy N.} and Chuck Fox and Ernest Moore and Alexis Cralley and Pedro Teixeira and Emily Leede and Frank Buchanan and Emilio Ramos and Marielle Ngoue and Nicole Fox and Lisa Shea and Martin Zielinski and Fischmann, {Marianna Martini} and Kenji Inaba and Desmond Khor and Gregory Magee and Malachi Sheahan and Marie Unruh and Neil Parry and Luc Dubois and John Berne and Gomez, {Mario F.} and Mark Davies and Jayakumar, {Lalithapriya (Priya)} and Sideman, {Matthew J.} and Christopher Mitromaras and Dimitrios Miserlis",

note = "Funding Information: The Aortic Trauma Foundation collaborators (primary investigators [if not listed in the Authors Contribution section, the contributions included data collection]): UTHealth: Naveed Saqib, MD, Kristofer Charlton-Ouw, MD, Rana Afifi, MD, Michelle McNutt, MD, Zain Al-Rustum, MD, Binod Shrestha, MD, and Edmundo Dipasupil, MD; University of Washington: Elina Quiroga, MD, and Ben Starnes, MD; Baylor College of Medicine/Ben Taub: Rami Gilani, MD; Loma Linda: David Turay, MD, and Xian Luo-Owen, MD; The University of Tennessee Health Science Center: Tiffany Bee, MD, and Suzanne Moyer, DNP, APRN, AG-ACNP; R Adams Cowley Shock Trauma Center: Joe DuBose, MD; Baylor Scott & White Health: William Shutze, MD, William Dockery, MD, Laura Petrey, MD, and Timothy N. Phelps, MD; Denver Health and Hospital Authority: Chuck Fox, MD, Ernest Moore, MD, and Alexis Cralley, MD; Dell Seton Medical Center: Pedro Teixeira, MD, Emily Leede, MD, Frank Buchanan, MD, Emilio Ramos, MD, and Marielle Ngoue, MD; Cooper University Hospital: Nicole Fox, MD, and Lisa Shea, MS, CCRC; Mayo Clinic Rochester: Martin Zielinski, MD, and Marianna Martini Fischmann, MD; LAC+USC Medical Center: Kenji Inaba, MD, Desmond Khor, MD, and Gregory Magee, MD; LSUHSC/University Medical Center in New Orleans: Malachi Sheahan, MD, and Marie Unruh, MD; London Health Sciences Centre: Neil Parry, MD, and Luc Dubois, MD; Broward Health: John Berne, MD, Ivan Puente, MD, Mario F. Gomez, DO, and Dalier R. Mederos, MD; Miami Valley Hospital/Premier Health: John Bini, MD, Karen Herzing RN, MSN, and Claire Hardman; UMASS Memorial Health Care: Andres Schanzer, MD, Francesco Aiello, MD, Edward Arous, MD, Elias Arous, MD, Douglas Jones, MD, Dejah Judelson, MD, Louis Messina, MD, Tammy Nguyen, MD, Jessica Simons, MD, and Robert Steppacher, MD; St. Michael's Hospital: Joao Rezende-Neto, MD; Via Christi Regional Medical Center: James Haan, MD, and Kelly Lightwine, MPH; Medical Center of the Rockies: Julie Dunn, MD, and Brittany Smoot; {\"O}rebro University Hospital: Tal Horer, MD, and David McGreevy, MD; Hospital Clinic de Barcelona: Vincent Riambau, MD, Gaspar Mestres, MD, and Xavier Yugueros, MD; University of Alabama at Birmingham: Marc Passman, MD, Adam W. Beck, MD, Mark Patterson, MD, Ben Pearce, MD, Emily Spangler, MD, Graeme McFarland, MD, and Danielle Sutzko, MD; St Louis University: Matt Smeds, MD, Emad Zakhary, MD, Michael Williams, MD, and Catherine Wittgen, MD; University of Missouri: Todd Vogel, MD; Massachusetts General Hospital: Matt Eagleton, MD; Cedars Sinai Medical Center: Ali Azizzadeh, MD, Bruce Gewertz, MD, Galinos Barmparas, MD, and Cassra Arbabi, MD; University of Maryland: Joseph DuBose, MD, Rishi Kundi, MD, and Jonathan Morrison, MD, PhD; Medical College of Wisconsin: Peter Rossi, MD; Sant'Orsola Hospital: Davide Pacini, MD, Luca Botta, MD, and Ciro Amodio, MD; Grande Ospedale Metropolitano Niguarda: Pierantonio Rimoldi, MD, Ilenia D'Alessio, MD, and Nicola Monzio Compagnoni, MD; University of Coloraro/UCHealth: Muhammad Aftab, MD, Mohammed Al-Musawi, MD, T. Brett Reece, MD, Jay D. Pal, MD, Donald Jacobs, MD, Rafael D. Malgor, MD, and Devin Zarkowsky, MD; Emory University at Grady Memorial: Ravi Rajani, MD, Jaime Benarroch-Gampel, MD, and Christopher R. Ramos, MD; Beth Israel Deaconess Medical Center: Marc Schermerhorn, MD, Mark Wyers, MD, Allen Hamdan, MD, Lars Stangenberg, MD, and Andy Lee, MD; University of Texas HSC San Antonio: Mark Davies, MD, Lalithapriya (Priya) Jayakumar, MD, Matthew J. Sideman, MD, Christopher Mitromaras, MD, Dimitrios Miserlis, MD, and Reshma Brahmbhatt, MD; Albany Medical College: Ralph Darling, MD, Xzabia Caliste, MD, Benjamin B. Chang, MD, Jeffrey C. Hnath, MD, Paul B. Kreienberg, MD, Alexander Kryszuk, MD, Adriana Laser, MD, Sean P. Roddy, MD, Stephanie Saltzberg, MD, Melissa Shah, MD, Courtney Warner, MD, and Chin-Chin Yeh, MD; Kirov Military Medical Academy: Viktor Reva, MD, Viktor Zhigalo, MD, and Alexander V. Krasikov, MD; Fondazione IRCCS Policlinico, Milan, Italy: Santi Trimarchi, MD, Maurizio Domanin, MD, and Ilenia D'Alessio, MD; University of Chicago: Trissa Babrowski, MD, Ross Milner, MD, Luka Pocivavsek, MD, and Christopher Skelly, MD; and Maine Medical Center: Kimberly Malka, MD, and Brian Nolan, MD; University Hospital of Trieste, ASUGI, Italy: Mario D'Oria, MD and Sandro Lepidi, MD. The editors and reviewers of this article have no relevant financial relationships to disclose per the JVS policy that requires reviewers to decline review of any manuscript for which they may have a conflict of interest. Publisher Copyright: {\textcopyright} 2021 Society for Vascular Surgery",

year = "2022",

month = feb,

doi = "10.1016/j.jvs.2021.08.084",

language = "English (US)",

volume = "75",

pages = "625--631",

journal = "Journal of Vascular Surgery",

issn = "0741-5214",

publisher = "Mosby Inc.",

number = "2",

}

TY - JOUR

T1 - Outcomes and practice patterns of medical management of blunt thoracic aortic injury from the Aortic Trauma Foundation global registry

AU - Aortic Trauma Foundation Study Group

AU - Arbabi, Cassra N.

AU - DuBose, Joseph

AU - Charlton-Ouw, Kristofer

AU - Starnes, Benjamin W.

AU - Saqib, Naveed

AU - Quiroga, Elina

AU - Miller, Charles

AU - Azizzadeh, Ali

AU - Afifi, Rana

AU - McNutt, Michelle

AU - Al-Rustum, Zain

AU - Shrestha, Binod

AU - Dipasupil, Edmundo

AU - Starnes, Ben

AU - Gilani, Rami

AU - Turay, David

AU - Luo-Owen, Xian

AU - Bee, Tiffany

AU - Moyer, Suzanne

AU - DuBose, Joe

AU - Shutze, William

AU - Dockery, William

AU - Petrey, Laura

AU - Phelps, Timothy N.

AU - Fox, Chuck

AU - Moore, Ernest

AU - Cralley, Alexis

AU - Teixeira, Pedro

AU - Leede, Emily

AU - Buchanan, Frank

AU - Ramos, Emilio

AU - Ngoue, Marielle

AU - Fox, Nicole

AU - Shea, Lisa

AU - Zielinski, Martin

AU - Fischmann, Marianna Martini

AU - Inaba, Kenji

AU - Khor, Desmond

AU - Magee, Gregory

AU - Sheahan, Malachi

AU - Unruh, Marie

AU - Parry, Neil

AU - Dubois, Luc

AU - Berne, John

AU - Gomez, Mario F.

AU - Davies, Mark

AU - Jayakumar, Lalithapriya (Priya)

AU - Sideman, Matthew J.

AU - Mitromaras, Christopher

AU - Miserlis, Dimitrios

N1 - Funding Information: The Aortic Trauma Foundation collaborators (primary investigators [if not listed in the Authors Contribution section, the contributions included data collection]): UTHealth: Naveed Saqib, MD, Kristofer Charlton-Ouw, MD, Rana Afifi, MD, Michelle McNutt, MD, Zain Al-Rustum, MD, Binod Shrestha, MD, and Edmundo Dipasupil, MD; University of Washington: Elina Quiroga, MD, and Ben Starnes, MD; Baylor College of Medicine/Ben Taub: Rami Gilani, MD; Loma Linda: David Turay, MD, and Xian Luo-Owen, MD; The University of Tennessee Health Science Center: Tiffany Bee, MD, and Suzanne Moyer, DNP, APRN, AG-ACNP; R Adams Cowley Shock Trauma Center: Joe DuBose, MD; Baylor Scott & White Health: William Shutze, MD, William Dockery, MD, Laura Petrey, MD, and Timothy N. Phelps, MD; Denver Health and Hospital Authority: Chuck Fox, MD, Ernest Moore, MD, and Alexis Cralley, MD; Dell Seton Medical Center: Pedro Teixeira, MD, Emily Leede, MD, Frank Buchanan, MD, Emilio Ramos, MD, and Marielle Ngoue, MD; Cooper University Hospital: Nicole Fox, MD, and Lisa Shea, MS, CCRC; Mayo Clinic Rochester: Martin Zielinski, MD, and Marianna Martini Fischmann, MD; LAC+USC Medical Center: Kenji Inaba, MD, Desmond Khor, MD, and Gregory Magee, MD; LSUHSC/University Medical Center in New Orleans: Malachi Sheahan, MD, and Marie Unruh, MD; London Health Sciences Centre: Neil Parry, MD, and Luc Dubois, MD; Broward Health: John Berne, MD, Ivan Puente, MD, Mario F. Gomez, DO, and Dalier R. Mederos, MD; Miami Valley Hospital/Premier Health: John Bini, MD, Karen Herzing RN, MSN, and Claire Hardman; UMASS Memorial Health Care: Andres Schanzer, MD, Francesco Aiello, MD, Edward Arous, MD, Elias Arous, MD, Douglas Jones, MD, Dejah Judelson, MD, Louis Messina, MD, Tammy Nguyen, MD, Jessica Simons, MD, and Robert Steppacher, MD; St. Michael's Hospital: Joao Rezende-Neto, MD; Via Christi Regional Medical Center: James Haan, MD, and Kelly Lightwine, MPH; Medical Center of the Rockies: Julie Dunn, MD, and Brittany Smoot; Örebro University Hospital: Tal Horer, MD, and David McGreevy, MD; Hospital Clinic de Barcelona: Vincent Riambau, MD, Gaspar Mestres, MD, and Xavier Yugueros, MD; University of Alabama at Birmingham: Marc Passman, MD, Adam W. Beck, MD, Mark Patterson, MD, Ben Pearce, MD, Emily Spangler, MD, Graeme McFarland, MD, and Danielle Sutzko, MD; St Louis University: Matt Smeds, MD, Emad Zakhary, MD, Michael Williams, MD, and Catherine Wittgen, MD; University of Missouri: Todd Vogel, MD; Massachusetts General Hospital: Matt Eagleton, MD; Cedars Sinai Medical Center: Ali Azizzadeh, MD, Bruce Gewertz, MD, Galinos Barmparas, MD, and Cassra Arbabi, MD; University of Maryland: Joseph DuBose, MD, Rishi Kundi, MD, and Jonathan Morrison, MD, PhD; Medical College of Wisconsin: Peter Rossi, MD; Sant'Orsola Hospital: Davide Pacini, MD, Luca Botta, MD, and Ciro Amodio, MD; Grande Ospedale Metropolitano Niguarda: Pierantonio Rimoldi, MD, Ilenia D'Alessio, MD, and Nicola Monzio Compagnoni, MD; University of Coloraro/UCHealth: Muhammad Aftab, MD, Mohammed Al-Musawi, MD, T. Brett Reece, MD, Jay D. Pal, MD, Donald Jacobs, MD, Rafael D. Malgor, MD, and Devin Zarkowsky, MD; Emory University at Grady Memorial: Ravi Rajani, MD, Jaime Benarroch-Gampel, MD, and Christopher R. Ramos, MD; Beth Israel Deaconess Medical Center: Marc Schermerhorn, MD, Mark Wyers, MD, Allen Hamdan, MD, Lars Stangenberg, MD, and Andy Lee, MD; University of Texas HSC San Antonio: Mark Davies, MD, Lalithapriya (Priya) Jayakumar, MD, Matthew J. Sideman, MD, Christopher Mitromaras, MD, Dimitrios Miserlis, MD, and Reshma Brahmbhatt, MD; Albany Medical College: Ralph Darling, MD, Xzabia Caliste, MD, Benjamin B. Chang, MD, Jeffrey C. Hnath, MD, Paul B. Kreienberg, MD, Alexander Kryszuk, MD, Adriana Laser, MD, Sean P. Roddy, MD, Stephanie Saltzberg, MD, Melissa Shah, MD, Courtney Warner, MD, and Chin-Chin Yeh, MD; Kirov Military Medical Academy: Viktor Reva, MD, Viktor Zhigalo, MD, and Alexander V. Krasikov, MD; Fondazione IRCCS Policlinico, Milan, Italy: Santi Trimarchi, MD, Maurizio Domanin, MD, and Ilenia D'Alessio, MD; University of Chicago: Trissa Babrowski, MD, Ross Milner, MD, Luka Pocivavsek, MD, and Christopher Skelly, MD; and Maine Medical Center: Kimberly Malka, MD, and Brian Nolan, MD; University Hospital of Trieste, ASUGI, Italy: Mario D'Oria, MD and Sandro Lepidi, MD. The editors and reviewers of this article have no relevant financial relationships to disclose per the JVS policy that requires reviewers to decline review of any manuscript for which they may have a conflict of interest. Publisher Copyright: © 2021 Society for Vascular Surgery

PY - 2022/2

Y1 - 2022/2

N2 - Objective: Blunt thoracic aortic injury (BTAI) is the second leading cause of death from blunt trauma. In the present study, we aimed to determine the outcomes of medical management (MM) for BTAI. We hypothesized from the results of several previously reported studies, that patients with a minimal aortic injury (BTAI grades 1 and 2) could safely be treated with definitive MM alone. Methods: The Aortic Trauma Foundation international prospective multicenter registry was used to examine the demographics, injury characteristics, management, and outcomes of patients with BTAI. We analyzed a subset of patients for whom MM was initiated as definitive therapy. Results: From November 2016 to April 2020, 432 patients (median age, 41 years; 76% male; median injury severity score, 34) with BTAI (Society for Vascular Surgery grade 1, 23.6%; grade 2, 14.4%; grade 3, 51.2%; grade 4, 10.9%) were evaluated. Of the 432 patients, 245 (57%) had received MM in the initial period and 114 (26.4%) had received MM as the planned definitive therapy (grade 1, 59.6%; grade 2, 23.7%; grade 3, 15.8%; grade 4, 0.9%). The most common mechanism of BTAI was a motor vehicle collision (60.4%). Hypotension was present on arrival in 74 patients (17.2%). Continuous titratable infusion of antihypertensive medication was used for 49.1%, followed by intermittent bolus administration (29.8%), with beta-blockers (74.6%) the most common agent used. Treatments were targeted to a goal systolic blood pressure for 83.3%, most often to a target goal systolic blood pressure <120 mm Hg (66.3%). The MM goals based on blood pressure control were attained in 64.0% (73 of 114). Twelve patients (10.5%; grade 1, 1; grade 2, 0; grade 3, 10; grade 4, 1) had required subsequent intervention after MM. Eleven patients (9.6%) had undergone thoracic endovascular aortic repair and one (0.9%) had required open repair for a grade 4 injury. The overall in-hospital mortality for patients selected for definitive MM was 7.9%. No aortic-related deaths had occurred in the patients receiving definitive MM. Conclusions: Approximately one in four patients with BTAI will receive MM as definitive therapy. The variation in the pharmacologic therapies used is considerable. MM for patients with minimal aortic injury (BTAI grades 1 and 2) is safe and effective, with a low overall intervention rate and no aortic-related deaths. These findings support the use of definitive MM for grade 2 BTAI.

AB - Objective: Blunt thoracic aortic injury (BTAI) is the second leading cause of death from blunt trauma. In the present study, we aimed to determine the outcomes of medical management (MM) for BTAI. We hypothesized from the results of several previously reported studies, that patients with a minimal aortic injury (BTAI grades 1 and 2) could safely be treated with definitive MM alone. Methods: The Aortic Trauma Foundation international prospective multicenter registry was used to examine the demographics, injury characteristics, management, and outcomes of patients with BTAI. We analyzed a subset of patients for whom MM was initiated as definitive therapy. Results: From November 2016 to April 2020, 432 patients (median age, 41 years; 76% male; median injury severity score, 34) with BTAI (Society for Vascular Surgery grade 1, 23.6%; grade 2, 14.4%; grade 3, 51.2%; grade 4, 10.9%) were evaluated. Of the 432 patients, 245 (57%) had received MM in the initial period and 114 (26.4%) had received MM as the planned definitive therapy (grade 1, 59.6%; grade 2, 23.7%; grade 3, 15.8%; grade 4, 0.9%). The most common mechanism of BTAI was a motor vehicle collision (60.4%). Hypotension was present on arrival in 74 patients (17.2%). Continuous titratable infusion of antihypertensive medication was used for 49.1%, followed by intermittent bolus administration (29.8%), with beta-blockers (74.6%) the most common agent used. Treatments were targeted to a goal systolic blood pressure for 83.3%, most often to a target goal systolic blood pressure <120 mm Hg (66.3%). The MM goals based on blood pressure control were attained in 64.0% (73 of 114). Twelve patients (10.5%; grade 1, 1; grade 2, 0; grade 3, 10; grade 4, 1) had required subsequent intervention after MM. Eleven patients (9.6%) had undergone thoracic endovascular aortic repair and one (0.9%) had required open repair for a grade 4 injury. The overall in-hospital mortality for patients selected for definitive MM was 7.9%. No aortic-related deaths had occurred in the patients receiving definitive MM. Conclusions: Approximately one in four patients with BTAI will receive MM as definitive therapy. The variation in the pharmacologic therapies used is considerable. MM for patients with minimal aortic injury (BTAI grades 1 and 2) is safe and effective, with a low overall intervention rate and no aortic-related deaths. These findings support the use of definitive MM for grade 2 BTAI.

KW - BTAI

KW - Blunt thoracic aortic injury

KW - Medical management

KW - TEVAR

KW - Thoracic endovascular aortic repair

KW - Vascular injury

UR - http://www.scopus.com/inward/record.url?scp=85117394503&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85117394503&partnerID=8YFLogxK

U2 - 10.1016/j.jvs.2021.08.084

DO - 10.1016/j.jvs.2021.08.084

M3 - Article

C2 - 34560220

AN - SCOPUS:85117394503

SN - 0741-5214

VL - 75

SP - 625

EP - 631

JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

IS - 2

ER -

Outcomes and practice patterns of medical management of blunt thoracic aortic injury from the Aortic Trauma Foundation global registry

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ASJC Scopus subject areas

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