Outcomes of non-operative management of higher grade (II-IV) of blunt traumatic aortic injury.

BACKGROUND

The current clinical practice guidelines for blunt traumatic aortic injury (BTAI) as set by the Society for Vascular Surgery recommend non-operative management in grade I injuries and thoracic endovascular aortic repair (TEVAR) or surgical repair for grade II-IV injuries. Several studies have reported successful non-operative management of grade I and II BTAI. However, non-operative management of BTAI greater than grade II has not been well-demonstrated. The purpose of this study is to examine outcomes in operative and non-operative management of patients with Grade II, III, and IV BTAI.

METHODS

In this retrospective study of 24 patients, the Hackensack Meridian Health Jersey Shore University Medical Center trauma registry and electronic medical record (2011-2021) were used to identify adults ([Formula: see text]18 years old) with grade II, III, and IV BTAI. Management was characterized as non-operative or operative. The primary outcome of this study was improvement of aortic injury which is defined as a lack of lesion progression or resolution of the lesion on a follow-up CT scan.

RESULTS

Non-operative patients had lower improvement percentages (33.3%) compared to the operative group (83.3%). Non-operative patients also had increased hospital mortality (66.7%) compared to the operative group (0%).

DISCUSSION: Patients with a higher grade BTAI showed greater improvement and had better outcomes with operative management, than non-operative management. However, large sample size studies are needed to verify these findings.