Natural History of Non-Operative Management of Grade II Blunt Thoracic Aortic Injury: A Ten Year Retrospective Analysis
Ann C. Gaffey, MD, Jason Zhang, BA, Erik Saka, MD, Jon G. Quatromoni, MD, Julia Glaser, MD, Patrick Kim, MD, Wilson Szeto, MD, Venkat Kalapatapu, MD
Hospital of the University of Pennsylvania, Philadelphia, PA
Objectives: The morbidity and mortality of blunt aortic injury (BAI) has been both diminished and revolutionized by the advent of endovascular repair. Nevertheless, the question remains as to what severity of injury requires endovascular repair. We therefore conducted a retrospective analysis of our experience with non-operative grade II BAI.
Methods: The records of patients with BAI from 2007 to 2017 at a Level I trauma center were retrospectively reviewed. Images were reviewed by a radiologist and graded according to the Society of Vascular Surgery Guidelines (grade I to IV). Demographics, injury severity, and outcomes were recorded.
Results: We identified 111 patients with BAI. Of these, 15 were deemed grade II injuries and were managed non-operatively. Mean patient age was 45 + 21 years; 60% of patients were male. The mean injury severity scale was 36 + 13. No patients had progression of BAI to a more severe grade requiring intervention. To date, the survival rate is 86.7% with a mean follow up of 69 months (range 7 to 138).
Conclusions: Within the grade II BIA cohort, injury progression did not occur, nor were any operative interventions performed. We support that grade II BAI can be managed non-operatively. However, given that progression of the BAI is possible, follow up aortic imaging is encouraged as well as appropriate blood pressure control.
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