Non-operative Management of Blunt Thoracic Aortic Injury

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.