REVIEW  THORACIC AORTIC CHALLENGES 

Italian Journal of Vascular and Endovascular Surgery 2020 March;27(1):76-84

DOI: 10.23736/S1824-4777.20.01429-1

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Unmet needs in the management of traumatic aortic injury

Anna N. ROMAGNOLI ¹ ✉, Joseph J. DUBOSE ²

¹ Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA, USA; ² Division of Trauma and Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, USA

Blunt traumatic aortic injury (BTAI) is a rare, but highly lethal, traumatic injury. Accruing data suggests that grade I and likely grade II injuries can safely be managed with medical therapy, while high-grade injuries (III, IV) require operative repair. Endovascular technology has largely supplanted open repair as first-line operative intervention. However, the complexity of the blunt trauma patient makes management decisions less than straightforward. Competing injury priorities, contraindications to anti-impulse therapy and anticoagulation therapy complicate decision-making in the management of BTAI. The development and implementation of a consensus grading system and treatment algorithm for the management of BTAI is necessary and will require multi-institutional study.

KEY WORDS: Vascular system injuries; Endovascular procedures; Wounds and injuries