72
Treatment
7.6.3. PAU Open Surgical Repair Versus Endovascular Repair
COR LOE
Recommendations
1 C-LD 1. In patients who require repair of a PAU in the ascending aorta
or proximal aortic arch (zones 0–1), open surgical repair is
recommended.
2a C-LD 2. In patients who require repair of a PAU in the distal aortic
arch (zones 2–3), descending thoracic aorta, or abdominal
aorta, either open surgical repair or endovascular repair is
reasonable, based on anatomy and medical comorbidities.
7.7.1.1. Initial Management of BTTAI in the Emergency
Department
COR LOE
Recommendations
1 C-EO 1. In patients with BTTAI, management and treatment at a
trauma center with the facilities and expertise to treat aortic
patholog y is recommended.
1 C-LD 2. In patients with BTTAI, anti-impulse therapy to reduce the
risk of injury extension and rupture should be implemented,
except in patients with hypotension or hypovolemic shock.
7.7.1.2. Approach to the Initial Management of BTTAI
COR LOE
Recommendations
1 C-LD 1. In patients with grade 1 BTTAI (Figure 23), nonoperative
management and follow-up imaging are recommended.
1 C-LD 2. In patients with grade 3 to 4 BTTAI (Figure 23) and
nonprohibitive comorbidities or injuries, aortic intervention
is recommended.
2a C-LD 3. In patients with grade 2 BTTAI (Figure 23) and with
high-risk imaging features (Table 32), aortic intervention is
reasonable.
2b C-LD 4. In patients with grade 2 BTTAI (Figure 23) and without high-
risk imaging features (Table 32), nonoperative management
and follow-up surveillance imaging may be reasonable.
