Endovascular repair of traumatic thoracic aortic injury: Clinical practice guidelines of the Society for Vascular Surgery

W. Anthony Lee, Jon S. Matsumura, R. Scott Mitchell, Mark A. Farber, Roy K. Greenberg, Ali Azizzadeh, Mohammad H Murad, Ronald M. Fairman

Research output: Contribution to journalArticle

271 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)187-192
Number of pages6
JournalJournal of Vascular Surgery
Volume53
Issue number1
DOIs
StatePublished - Jan 2011

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Thoracic Injuries
Practice Guidelines
Meta-Analysis
Thorax
Spinal Cord Ischemia
Subclavian Artery
Practice Management
Wounds and Injuries
Drainage
Observation
Transplants
Kidney
Survival
Mortality
Infection

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Lee, W. A., Matsumura, J. S., Mitchell, R. S., Farber, M. A., Greenberg, R. K., Azizzadeh, A., ... Fairman, R. M. (2011). Endovascular repair of traumatic thoracic aortic injury: Clinical practice guidelines of the Society for Vascular Surgery. Journal of Vascular Surgery, 53(1), 187-192. https://doi.org/10.1016/j.jvs.2010.08.027

Endovascular repair of traumatic thoracic aortic injury : Clinical practice guidelines of the Society for Vascular Surgery. / Lee, W. Anthony; Matsumura, Jon S.; Mitchell, R. Scott; Farber, Mark A.; Greenberg, Roy K.; Azizzadeh, Ali; Murad, Mohammad H; Fairman, Ronald M.

In: Journal of Vascular Surgery, Vol. 53, No. 1, 01.2011, p. 187-192.

Research output: Contribution to journalArticle

Lee, W. Anthony ; Matsumura, Jon S. ; Mitchell, R. Scott ; Farber, Mark A. ; Greenberg, Roy K. ; Azizzadeh, Ali ; Murad, Mohammad H ; Fairman, Ronald M. / Endovascular repair of traumatic thoracic aortic injury : Clinical practice guidelines of the Society for Vascular Surgery. In: Journal of Vascular Surgery. 2011 ; Vol. 53, No. 1. pp. 187-192.
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