Non-operative Management of Blunt Thoracic Aortic Injury

  • James H. HolmesIV
  • R. Alan Hall
  • Riyad C. Karmy-Jones


Traditionally, blunt thoracic aortic injury (BTAI) has been considered an absolute surgical emergency with immediate repair being the standard of care. This philosophy arose from Parmley’s 1958 seminal study documenting a death rate at the scene of up to 85%, and a subsequent mortality rate in non-operated survivors of 1% per hour for the first 48 hours. However, this report was a military autopsy study encompassing mechanisms of injury rarely witnessed in civilian trauma centers and reflecting the outcome of only the most severely injured who ultimately died. In the past decade, there has been a change in the management philosophy of BTAI with emphasis on blood pressure control and assessing the need for emergent repair against the risks of operation due to associated injuries or premorbid conditions.


Cardiac Risk Factor Close Head Injury Aortic Injury Pulmonary Injury Traumatic Rupture 
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Selected References

  1. Akins CW, Buckley MJ, Daggett W, McIlduff JB, Austen WG. Acute traumatic disruption of the thoracic aorta: a ten-year experience. Ann Thorac Surg 1981; 31(4): 305–9.PubMedCrossRefGoogle Scholar
  2. Camp PC, Shackford SR, WTA Multicenter Study Group. Outcome after blunt traumatic thoracic aortic laceration: identification of a high-risk cohort. J Trauma 1997;43:413–422.PubMedCrossRefGoogle Scholar
  3. Fabian TC, Davis KA, Gavant ML, et al. Prospective study of blunt aortic injury-helical CT is diagnostic and antihypertensive therapy reduces rupture. Ann Surg 1998; 227: 666–677.PubMedCrossRefGoogle Scholar
  4. Holmes JH 4th, Bloch RD, Hall RA, et al. Natural history of traumatic rupture of the thoracic aorta managed non-operatively: a longitudinal analysis. Ann Thorac Surg 2002; in press.Google Scholar
  5. Karmy-Jones R, Carter YM, Nathens A, et al. Impact of presenting physiology and associated injuries on outcome following traumatic rupture of the thoracic aorta. Am Surg 2001; 67: 61–66.PubMedGoogle Scholar
  6. Maggisano R, Nathens A, Alexandrova NA, et al. Traumatic rupture of the thoracic aorta: should one always operate immediately? Ann Vasc Surg 1995; 9: 44–52.PubMedCrossRefGoogle Scholar
  7. Malhotra AK, Fabian TC, Croce MA, et al. Minimal aortic injury: a lesion associated with advancing diagnostic techniques. J Trauma 2001; 51: 1042–1048.PubMedCrossRefGoogle Scholar
  8. Mattox KL, Wall MJ Jr. Historical review of blunt injury to the thoracic aorta. Chest Surg Clin N Am 2000; 10(1): 167–182.PubMedGoogle Scholar
  9. Parmley LF, Mattingly TW, Manion WJ, et al. Nonpenetrating traumatic injury to the aorta. Circulation 1958; 17:1086–1101.PubMedCrossRefGoogle Scholar
  10. Pate JW, Fabian TC, Walker W. Traumatic rupture of the aortic isthmus: an emergency? World J Surg; 19: 119–126.Google Scholar
  11. Pate JW, Gavant ML, Weiman DS, et al. Traumatic rupture of the aortic isthmus: program of selective management. World J Surg 1999; 23: 59–63.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2002

Authors and Affiliations

  • James H. HolmesIV
  • R. Alan Hall
  • Riyad C. Karmy-Jones

There are no affiliations available

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