Society for Vascular Surgery® document
From the Society for Vascular Surgery
Endovascular repair of traumatic thoracic aortic injury: Clinical practice guidelines of the Society for Vascular Surgery

Presented at the 2010 Vascular Annual Meeting of the Society for Vascular Surgery, June 10-13, 2010, Boston, Mass.
https://doi.org/10.1016/j.jvs.2010.08.027Get rights and content
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The Society for Vascular Surgery® pursued development of clinical practice guidelines for the management of traumatic thoracic aortic injuries with thoracic endovascular aortic repair. In formulating clinical practice guidelines, the Society selected a panel of experts and conducted a systematic review and meta-analysis of the literature. They used the Grading of Recommendations Assessment, Development and Evaluation methods (GRADE) to develop and present their recommendations. The systematic review included 7768 patients from 139 studies. The mortality rate was significantly lower in patients who underwent endovascular repair, followed by open repair, and nonoperative management (9%, 19%, and 46%, respectively, P < .01). Based on the overall very low quality of evidence, the committee suggests that endovascular repair of thoracic aortic transection is associated with better survival and decreased risk of spinal cord ischemia, renal injury, graft, and systemic infections compared with open repair or nonoperative management (Grade 2, Level C). The committee was also surveyed on a variety of issues that were not specifically addressed by the meta-analysis. On these select matters, the majority opinions of the committee suggest urgent repair following stabilization of other injuries, observation of minimal aortic defects, selective (vs routine) revascularization in cases of left subclavian artery coverage, and that spinal drainage is not routinely required in these cases.

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Competition of interest: Dr Lee received research support and consultation fees from Cook, Medtronic, and Bolton Medical. Dr Matsumura has grants for research and training from Abbott, Cook, Covidien, Endologix, and W. L. Gore. Dr Mitchell has no conflict of interest disclosures. Dr Farber received consultant fees from W. L. Gore, Medtronic, Cook, Aptus Endosystems, and Bolton Medical. Dr Greenberg received research support from Cook and W. L. Gore. He has IP/License agreements with Cook. Dr Azizzadeh received consultation fees from Medtronic and W. L. Gore. Dr Murad has no conflict of interest disclosures. Dr Fairman received research support from Abbott, Medtronic, Cook, Aptus, and Boston Scientific.

Independent peer-review and oversight has been provided by members of the SVS Document Oversight Committee (K. Wayne Johnston, MD (chair), Enrico Ascher, MD, Jack L. Cronenwett, MD, R. Clement Darling, MD, Vivian Gahtan, MD, Peter Gloviczki, MD, Thomas F. Lindsay, MD, Gregorio A. Sicard, MD).