SVS Updates Guidelines for Blunt Thoracic Aortic Injury

March 24, 2026—The Society for Vascular Surgery (SVS) announced the release of an updated clinical practice guideline on the management of blunt thoracic aortic injury (BTAI). The guideline provides 13 updated recommendations based on the latest published evidence in the management of BTAI since the previous guideline was published in 2011, noted SVS.

Joseph DuBose, MD, et al published the guideline in Journal of Vascular Surgery. Ali Azizzadeh, MD, is Chair of the guideline writing group.

According to SVS, the updated guidelines include recommendations addressing when surgery is necessary, when nonoperative management is appropriate, how patients should be monitored, and how to manage complex cases involving additional traumatic injuries—including traumatic brain injury (TBI), solid organ injury (SOI), and pelvic fractures.

As outlined in the SVS press release, key recommendations include the following:

• Nonoperative management for grades 1 and 2 BTAI:
  • In patients with grades 1 and 2 BTAI (minimal aortic injury), the guidelines recommend definitive nonoperative management versus thoracic endovascular aortic repair (TEVAR) or open repair.
  • Grade 1 injuries require no routine follow-up imaging.
  • Grade 2 injuries should undergo one follow-up CT angiography to ensure resolution.
• Timing of repair in grade 3 injuries:
  • In patients with hemodynamically stable grade 3 BTAI, the guidelines suggest delayed TEVAR (> 24 hours) to allow for management of other associated traumatic injuries if needed.
  • In an unstable patient with concern that the BTAI is the specific cause for the patient’s instability, urgent (< 24 hours) or emergent intervention is recommended.
• Management of patients with concomitant TBI or SOI:
  • In patients with grades 1 or 2 BTAI and concomitant TBI, anti-impulse therapy is not recommended, and blood pressure management should prioritize TBI versus BTAI.
  • For grade 3 injuries with TBI or SOI, decisions regarding anti-impulse therapy and timing of TEVAR should be individualized and made collaboratively with other stakeholders, including trauma and neurosurgery.
  • Emergent repair is recommended for grade 4 injuries.
  • For patients with BTAI and concomitant TBI or SOI, SVS suggests a collaborative approach for intraprocedural anticoagulation during TEVAR.