74
Treatment
Table 32. High-Risk Imaging Features of BTTAI
• Posterior mediastinal hematoma >10 mm
• Lesion to normal aortic diameter ratio >1.4
• Mediastinal hematoma causing mass effect
• Pseudocoarctation of the aorta
• Large left hemothorax
• Ascending aortic, aortic arch, or great vessel involvement
• Aortic arch hematoma
7.7.2. Initial Management of Blunt Traumatic Abdominal
Aortic Injury (BAAI)
COR LOE
Recommendations
1 C-LD 1. In patients with grade 1 to 2 BAAI (Table 33) without
malperfusion, anti-impulse therapy, if clinically tolerated,
and repeat imaging within 24 to 48 hours of the initial scan is
recommended to reduce risk of injury progression.
1 C-LD 2. In patients with grade 4 BAAI (Table 33), repair should be
performed to address life-threatening aortic injury.
2a C-LD 3. In patients with grade 2 BAAI (Table 33) and associated
malperfusion, it is reasonable to consider repair.
2a C-LD 4. In patients with BAAI, treatment with either endovascular
or open repair is reasonable and depends on degree of injury,
aortic anatomy, and the patient's overall clinical status.
2b C-LD 5. In patients with grade 3 BAAI (Table 33), it may be
reasonable to consider repair to reduce risk of progression to
life-threatening injury.
3: Harm B-NR 6. In patients with BAAI, the usefulness of routine application
of resuscitative endovascular balloon occlusion of the aorta
(REBOA) for hemorrhage control is unclear and, in some
cases, may cause harm.
7.7.1.3. Endovascular Versus Open Surgical Repair
COR LOE
Recommendation
1 B-NR 1. In patients with BTTAI who meet indications for repair and
with appropriate anatomy, TEVAR is recommended over
open repair.
