Observational management of Grade II or higher blunt traumatic thoracic aortic injury: 15 years of experience at a single suburban institution

Jin Bong Ye; Jin Young Lee; Jin Suk Lee; Se Heon Kim; Hanlim Choi; Yook Kim; Soo Young Yoon; Young Hoon Sul; Jung Hee Choi

doi:10.4103/ijciis.ijciis_89_21

Observational management of Grade II or higher blunt traumatic thoracic aortic injury: 15 years of experience at a single suburban institution

Int J Crit Illn Inj Sci. 2022 Apr-Jun;12(2):101-105. doi: 10.4103/ijciis.ijciis_89_21. Epub 2022 Jun 24.

Authors

Jin Bong Ye¹, Jin Young Lee¹, Jin Suk Lee¹, Se Heon Kim¹, Hanlim Choi², Yook Kim³, Soo Young Yoon⁴, Young Hoon Sul^{1

5}, Jung Hee Choi⁶

Affiliations

¹ Department of Trauma Surgery, Trauma Center, Chungbuk National University Hospital, Cheongju, Korea.
² Department of Surgery, Chungbuk National University Hospital, Cheongju, Korea.
³ Department of Radiology, Chungbuk National University Hospital, Cheongju, Korea.
⁴ Department of Cardiovascular and Thoracic Surgery, Trauma Center, Chungbuk National University Hospital, Cheongju, Korea.
⁵ Department of Trauma Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea.
⁶ Anesthesiology and Pain Medicine, Chungbuk National University Hospital, Cheongju, Korea.

Abstract

Background: We aimed to investigate the outcomes after delayed management of ≥ Grade II blunt traumatic thoracic aortic injury (BTAI).

Methods: Between January 2005 and December 2019, we retrospectively reviewed the medical records of 21 patients with ≥ Grade II thoracic aortic injury resulting from blunt trauma. Twelve patients underwent observation for the injury, whereas nine patients were transferred immediately after the diagnosis. Patients were divided into a nonoperative management group (n = 7) and delayed repair group (n = 5) based on whether they underwent thoracic endovascular aneurysm repair or surgery.

Results: The most common dissection type was DeBakey classification IIIa (n = 9). Five patients underwent delayed surgery (including aneurysm repair), with observation periods ranging from 1 day to 36 months. The delayed repair group exhibited higher injury severity scores than the nonoperative management group (n = 7). The nonoperative management group was followed-up with blood pressure management without a change in status for a period ranging from 3 to 96 months.

Conclusions: Our findings indicated that conservative management may be appropriate for select patients with Grade II/III BTAI, especially those exhibiting hemodynamic stability with anti-impulse therapy and minimally sized pseudoaneurysms. However, further studies are required to identify the risk factors for injury progression and long-term outcomes.

Keywords: Endovascular procedure; thoracic aorta; vascular injury.