Endovascular repair of traumatic thoracic aortic injury: clinical practice guidelines of the Society for Vascular Surgery.
The Society for Vascular Surgery® pursued development of clinical practice guidelines for the management of traumatic thoracic aortic injuries with thoracic endovascular aortic repair. In formulating clinical practice guidelines, the Society selected a panel of experts and conducted a systematic review and meta-analysis of the literature. They used the Grading of Recommendations Assessment, Development and Evaluation methods (GRADE) to develop and present their recommendations. The systematic review included 7768 patients from 139 studies. The mortality rate was significantly lower in patients who underwent endovascular repair, followed by open repair, and nonoperative management (9%, 19%, and 46%, respectively, P < .01). Based on the overall very low quality of evidence, the committee suggests that endovascular repair of thoracic aortic transection is associated with better survival and decreased risk of spinal cord ischemia, renal injury, graft, and systemic infections compared with open repair or nonoperative management (Grade 2, Level C). The committee was also surveyed on a variety of issues that were not specifically addressed by the meta-analysis. On these select matters, the majority opinions of the committee suggest urgent repair following stabilization of other injuries, observation of minimal aortic defects, selective (vs routine) revascularization in cases of left subclavian artery coverage, and that spinal drainage is not routinely required in these cases.
Christine E. Lynn Heart and Vascular Institute, Boca Raton, FL, USA. walee@sapbc.net
W Anthony
WA
Lee
Jon S
JS
Matsumura
R Scott
RS
Mitchell
Mark A
MA
Farber
Roy K
RK
Greenberg
Ali
A
Azizzadeh
Mohammad Hassan
MH
Murad
Ronald M
RM
Fairman
D000328:Adult; D001013:Aorta, Thoracic / Q000293:injuries* / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000592:standards; D057510:Endovascular Procedures; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D012955:Societies, Medical; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D014949:Wounds, Nonpenetrating