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Nonoperative Management for Low-Grade Blunt Thoracic Aortic Injury.

Simin Golestani1, Joseph J Dubose, Jessica Efird

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Nonoperative management (NOM) alone is safe for low-grade blunt thoracic aortic injury (BTAI), showing lower mortality than thoracic endovascular aortic repair (TEVAR). NOM is appropriate for these injuries, reducing complications and mortality.

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Area of Science:

  • Cardiovascular Surgery
  • Trauma Surgery
  • Vascular Surgery

Background:

  • Thoracic endovascular aortic repair (TEVAR) is standard for blunt thoracic aortic injury (BTAI).
  • Low-grade BTAI (intimal tears or intramural hematoma) may resolve with nonoperative management (NOM).
  • No direct comparison exists for NOM versus TEVAR in low-grade BTAI.

Purpose of the Study:

  • To compare the safety and efficacy of NOM versus TEVAR for low-grade BTAI.
  • To test the hypothesis that NOM alone is sufficient for low-grade BTAI.

Main Methods:

  • Retrospective analysis of 269 patients with low-grade BTAI from the Aortic Trauma Foundation Registry (2016-2021).
  • Comparison of outcomes between patients treated with NOM alone (n=218) and those treated with TEVAR (n=51).
  • Primary outcome was mortality; secondary outcomes included complications, ICU length of stay, and ventilator days.

Main Results:

  • No demographic or injury mechanism differences between NOM and TEVAR groups.
  • Overall mortality was significantly lower in the NOM group (8%) compared to the TEVAR group (18%; p=0.009).
  • Aortic-related mortality was 0.5% for NOM versus 4% for TEVAR (p=0.06); no significant differences in other complications or resource utilization.

Conclusions:

  • Nonoperative management alone is a safe and appropriate strategy for low-grade BTAI.
  • NOM is associated with lower mortality and fewer complications compared to initial TEVAR for low-grade BTAI.