Delayed management of grade III blunt aortic injury: Series from a level-I trauma center.

Objective: Blunt aortic injuries (BAI) are traditionally treated as surgical emergencies, with the majority of repairs performed in an urgent fashion within 24 hours, irrespective of the grade of aortic injury. These patients are often under-resuscitated and often have multiple other trauma issues that need to be addressed. This study reviews a single center's experience comparing urgent (24 hours) TEVAR for grade III blunt aortic injury. Methods: All patients undergoing TEVAR for BAI at a single institution between March 2004 and March 2014 were reviewed (n=43). Patients with grade I, II, or IV aortic injuries as well as those who were repaired with an open procedure or who lacked preoperative imaging were excluded from analysis. Demographics, intraoperative data, postoperative survival and complications were compared. Results: Over this time period, there were 43 patients with blunt thoracic aortic injury. There were 29 patients with grade 3 or higher aortic injuries. 1/29 declined surgery, 2/29 were repaired open, 10/29 underwent urgent TEVAR, and 16/29 had initial observation. Of these 16, 13/16 underwent TEVAR in a delayed fashion (median 9 days, range 2-91 days) and three died from non-aortic related pathology. Comparing the immediate repair group vs. the delayed repair group, there were no significant demographic differences. Trauma classification scores were similar, although patients in the delayed group had a higher number of non-aortic injuries. The 30-day survival was similar between the two groups (9/10 vs. 12/16), with no mortalities due to aortic pathology in either group. Conclusions: Watchful waiting may be permissible in patients with grade III blunt aortic injury with other associated multi-system trauma. This allows for a repair in a more controlled environment (C) 2016 Lippincott Williams & Wilkins, Inc.

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