Attilio Cotroneo: Updated Evidence-Based Recommendations for the Management of BTAI
Attilio Cotroneo, Cardiovascular Surgeon at Policlinico San Donato, shared a post on LinkedIn about a recent article by Joseph DuBose et al. published in Journal of Vascular Surgery:
“Blunt thoracic aortic injury (BTAI) remains a devastating and potentially fatal complication of major trauma that requires expedient diagnosis and management by a collaborative team of trauma and vascular specialists.
Trauma patients with BTAI commonly have multiple associated injuries, including intracranial or truncal hemorrhage, that increase the complexity of factors related to timing and conduct of repair.
Optimal outcomes for these patients require consideration of these factors and updated knowledge of the available evidence by all stakeholders of care in a collaborative fashion.
In 2011, the Society for Vascular Surgery published its clinical practice guidelines on the management of BTAI. Based on the available evidence from published research at the time, seven specific key questions were formulated spanning areas including patient selection, timing and conduct of repair, considerations in the setting of specific high-risk associated injuries, and surveillance.
A systematic review and evidence synthesis of each question was conducted by a dedicated methodology team.
The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach was used to describe the strength of each recommendation and the level of certainty of evidence.
The review identified major gaps in evidence across most of the questions posed, highlighting opportunities for additional research.
Since that publication in 2011, the cumulative experience in the diagnosis and management of BTAI has grown significantly.
This provided an opportunity for a focused update based on the current evidence.
We assembled a panel of experts who identified seven specific areas of investigation and commissioned a systematic review of the published literature.
Thirteen recommendations are provided in the current update.
They address indications for and timing of definitive treatment, use of perioperative anticoagulation, management of the left subclavian artery, and imaging surveillance.
In addition, we discuss the use of anti-impulse therapy for medical management as well as BTAI management for patients with concomitant injuries such as traumatic brain injury and solid organ injury.
The collaborative engagement of all stakeholders in care of these complex patients is considered fundamental to optimal care.
Significant unmet research needs in the field are also outlined.”
Title: The society for vascular surgery clinical practice guideline on the management of blunt thoracic aortic injury: A focused update.
Authors: Joseph DuBose, Rishi Kundi, Michael A Curi, Matthew Eagleton, Mark K Eskandari, Sagar Gandhi, Rafael D Malgor, Erica L Mitchell, M Hassan Murad, Elina Quiroga, Ravi R Rajani, Timur Sarac, Ali Azizzadeh
Read the Full Article on Journal of Vascular Surgery
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