Close surveillance imaging is unnecessary for patients with grade I blunt thoracic aortic injury


      • As CT image quality improves, smaller traumatic injuries are increasingly being identified.
      • Grade I blunt thoracic aortic injuries do not require immediate repair nor worsen to require later operative intervention.
      • Thus, close surveillance imaging is not necessary for grade I injuries.



      No evidence-based recommendations exist for imaging surveillance of grade I blunt thoracic aortic injuries (BTAI). We aimed to evaluate the natural history of these injuries to provide guidance for follow-up imaging.


      Patients that presented to our trauma center from 2008 to 2021 with grade I BTAI were retrospectively evaluated. CT angiography images were assessed for initial injury grade and subsequent stability, improvement, worsening, or resolution.


      Of 83 patients who had grade I injuries and repeat imaging, 57.8% had complete resolution, 20.5% had improvement, and 18.1% had stability of their injury. Only seven patients (8.4%) demonstrated worsening of their injury. Six patients had eventual resolution and one underwent endovascular repair that would not have been performed under current practice patterns.


      Since grade I injuries do not worsen to require later surgical intervention, early surveillance imaging is not necessary and further imaging may not be necessary at all.

      Graphical abstract



      BTAI (blunt thoracic aortic injury), SVS (Society of Vascular Surgery), CTA (CT angiography)
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