Simeone et al reported a grading system for blunt aortic trauma (BAI) at the aortic isthmus. This can help guide management. The authors are from Yale University.
Patient selection: blunt aortic trauma (BAI) at the aortic isthmus
Aortic isthmus: between origin of left subclavian aorta and ductus arteriosus
Findings on CT
Grade
intimal irregularity less than 1 cm with minimal periaortic hematoma
I
intimal flap > 1 cm with or without pseudoaneurysm
II
"shattered" (circumferential or near-circumferential disruption)
III
active contrast extravasation; pseudo-coarctation; dissection; distal ischemia
IV
Grade
Significant Injury
Management
I
NA
medical management with close follow-up
II or III
no
urgent intervention
II or III
yes
endovascular stent graft or delayed surgical intervention
IV
NA
immediate intervention
where:
• Significant injury may include: significant intracranial injury; Grade IV or V liver injury; pulmonary contusion with hypoxemia; severe comorbidities; contaminated wounds.
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