SVS Issues Guidelines for Endovascular Repair of Traumatic Thoracic Aortic Injury

October 25, 2010—W. Anthony Lee, MD, et al have published the Society for Vascular Surgery's clinical practice guidelines for the management of traumatic thoracic aortic injuries with thoracic endovascular aortic repair. The guidelines were published online ahead of print in the Journal of Vascular Surgery.

In formulating clinical practice guidelines, the society selected a panel of experts and conducted a systematic review and meta-analysis of the literature. The panel used the Grading of Recommendations Assessment, Development and Evaluation methods (GRADE) to develop and present their recommendations.

As detailed in the Journal of Vascular Surgery, the systematic review included 7,768 patients from 139 studies. The guidelines reported that 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, and 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.