• Simin Golestani, Joseph J Dubose, Jessica Efird, Pedro G Teixeira, Tatiana C Cardenas, Marc D Trust, Sadia Ali, Jayson Aydelotte, James Bradford, and Carlos Vr Brown.
• From the Department of Surgery, Dell Medical School, University of Texas at Austin.
• J. Am. Coll. Surg. 2024 Feb 26.

BackgroundThoracic endovascular aortic repair (TEVAR) is the standard of care for the treatment of blunt thoracic aortic injuries (BTAI) requiring intervention. Data suggests that low grade BTAI (Grade 1 [intimal tears] or Grade 2 [intramural hematoma]) will resolve spontaneously if treated with non operative management (NOM) alone. There has been no comparison specifically between the use of NOM vs. TEVAR for low grade BTAI. We hypothesize that these low-grade injuries can be safely managed with NOM alone.Study DesignRetrospective analysis of all patients with a low grade BTAI in the Aortic Trauma Foundation Registry from 2016 to 2021 was performed. The study population was 1primary outcome was mortality. Secondary outcomes included complications, ICU length of stay, and ventilatory days.Results880 patients with BTAI were enrolled. Of the 269 patients with low grade BTAI, 218 (81%) were treated with NOM alone (81% Grade I, 19% Grade II), while 51 (19%) underwent a TEVAR (20% Grade I, 80% Grade II). There was no difference in demographics or mechanism of injury in low grade BTAI patients who underwent NOM vs. TEVAR. There was a difference in mortality between NOM alone and TEVAR (8% vs. 18%, p=0.009). Aortic-related mortality was 0.5% in the NOM group and 4% in the TEVAR group (p=0.06). Hospital and ICU length of stay, and ventilator days were not different between the two groups.ConclusionsNOM alone is safe and appropriate management for low grade BTAIs, with lower mortality and decreased rates of complications when compared to routine initial TEVAR.Copyright © 2024 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.

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