Guideline Video

Guideline Resources

  • Management of Blunt Thoracic Aortic Injury
  • Society for Vascular Surgery
  • March 24, 2026
  • Summary
  • Full-text

Video Transcription

Just published March 24th, 2026, the Society for Vascular Surgery’s newest guideline on Management of Blunt Thoracic Aortic Injury.

The recommendations in this guideline address indications for and timing of definitive treatment, use of perioperative anticoagulation, management of the left subclavian artery, and imaging surveillance.

In today’s rapid update, we’ll be just be going over a summary of recommendations so for the full guideline, make sure to check it out on guidelinecentral.com

Let’s get started. 

  • In patients with grade 1 and 2 blunt thoracic aortic injury, or BTAI, (minimal aortic injury [MAI]), the guideline recommends definitive nonoperative management over thoracic endovascular aortic repair, also known as TEVAR, or open repair. Grade 1 injuries require no routine follow-up imaging. The guideline suggests grade 2 injuries undergo one follow-up computed tomography angiography, or CTA, to ensure resolution.
  • In patients with hemodynamically stable grade 3 BTAI, the guideline suggests delayed TEVAR to allow for management of other associated traumatic injuries if needed. In an unstable patient in whom there is a concern that the BTAI is the specific cause of the patient's instability, the guideline recommends urgent or emergent intervention. 
  • Among patients requiring left subclavian artery, or LSA, coverage for TEVAR after BTAI, the guideline suggests that the decision regarding LSA revascularization be based on feasibility and factors such as a patent prior left internal mammary to coronary bypass, detection of a dominant left vertebral artery on preoperative or intraoperative imaging, or an aortic origin of the left vertebral artery.
  • In patients with BTAI undergoing TEVAR, the guideline suggests that intraoperative anticoagulation can be used at the surgeon's discretion after considering the risk of bleeding and thrombotic complications.
  • In all patients with grade 1 BTAI treated nonoperatively, the guideline suggests against routine surveillance imaging. 
  • In patients with grade 2 BTAI treated nonoperatively, the guideline suggests at least one follow-up surveillance imaging study. The guideline suggests repeat imaging at 1 to 3 months after injury. 
  • In patients who had TEVAR for BTAI, the guideline suggests postoperative surveillance imaging.
  • In patients with grade 1 or 2 BTAI (MAI) and concomitant traumatic brain injury, or TBI, the guideline suggests against anti-impulse therapy for BTAI. Management of blood pressure should prioritize TBI over BTAI. 
  • In patients with grade 3 BTAI and concomitant TBI, the guideline suggests that the decision to use anti-impulse therapy should be individualized based on collaborative management with other surgical and medical specialties. 
  • In patients with grade 3 BTAI and concomitant TBI or solid organ injury, the guideline suggests that timing for TEVAR should be determined in a collaborative fashion in consultation with other stakeholders, including trauma and neurosurgery. 
  • In patients with grade 4 BTAI, the guideline recommends emergent repair. 
  • For patients with BTAI and concomitant TBI or solid organ injury, the guideline suggests a collaborative approach for intraprocedural anticoagulation during TEVAR. Although current observational studies do provide some reassurance that heparinization is not associated with worse intracranial bleeding or neurologic outcomes, the certainty in this evidence is very low.
  • In patients with grade 3 BTAI, the guideline suggests anti-impulse therapy as a stabilizing measure until TEVAR is performed if the concomitant injuries do not preclude this approach.

And there you have it. Make sure to check out the full guideline from the Society for Vascular Surgery and other related clinical decision support tools at guidelinecentral.com.

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