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

      Highlights

      • 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.

      Abstract

      Background

      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.

      Methods

      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.

      Results

      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.

      Conclusions

      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

      Keywords

      Abbreviations:

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