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

Graphical Abstract
Keywords
Abbreviations:
BTAI (blunt thoracic aortic injury), SVS (Society of Vascular Surgery), CTA (CT angiography)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Functional and survival outcomes in traumatic blunt thoracic aortic injuries: an analysis of the National Trauma Databank.J Vasc Surg. 2009; 49: 988-994
- Blunt aortic injury.N Engl J Med. 2008; 359: 1708-1716
- Blunt thoracic aortic injury.J Cardiothorac Trauma. 2018; 3: 11-18
- Blunt traumatic aortic injury: initial experience with endovascular repair.J Vasc Surg. 2009; 49: 1403-1408
- Endovascular repair of traumatic thoracic aortic injury: clinical practice guidelines of the Society for Vascular Surgery.J Vasc Surg. 2011; 53: 187-192
- A new classification scheme for treating blunt aortic injury.J Vasc Surg. 2012; 55: 47-54
- Do patients with minimal blunt thoracic aortic injury require thoracic endovascular repair?.J Trauma acute care Surg. 2021; 90: 384-387
- Determinants and outcomes of nonoperative management for blunt traumatic aortic injuries.J Vasc Surg. 2018; 67: 389-398
- Nonpenetrating traumatic injury of the aorta.Circulation. 1958; 17: 1086-1101
- Permissive hypotension in traumatic brain injury with blunt aortic injury: how low can we go?.J Anaesthesiol Clin Pharmacol. 2014; 30: 406-408
- Use of spiral computed tomography for the assessment of blunt trauma patients with potential aortic injury.J Trauma. 1998; 45: 922-930
- Blunt thoracic aortic injury: endovascular repair is now the standard.J Am Coll Surg. 2019; 228: 605-610
- Prospective study of blunt aortic injury: multicenter trial of the American association for the Surgery of trauma.J Trauma acute care Surg. 1997; 42: 374-383
- Call for a new classification system and treatment strategy in blunt aortic injury.J Vasc Surg. 2016; 64: 171-176
- Natural history of grade I-II blunt traumatic aortic injury.J Vasc Surg. 2014; 59: 334-341
Article info
Publication history
Published online: June 09, 2022
Accepted:
June 7,
2022
Received in revised form:
May 31,
2022
Received:
April 25,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.