Department of Cardiothoracic & Vascular Surgery McGovern Medical School / The University of Texas Health Science Center at Houston

Joseph J. DuBose, MD; FACS FCCM

Traumatic Aortic Injury: Update From The Aortic Trauma Foundation

Lt Col USAF MC Associate Professor of Surgery

Uniformed Services University of the Health Sciences

Associate Professor of Surgery

University of Maryland Medical System

R Adams Cowley Shock Trauma Center

Disclosures

• The contents of this presentation do not

represent any position of the Department of

Defense or the United States Air Force

• Secretary – Aortic Trauma Foundation

• Volunteer, No compensation

• Non-Profit organization

Blunt Thoracic Aortic Injury

Mortality Reduction of 2% /

year (p

0

5

10

15

20

25

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

BTAImanagement2002-2014

Openrepair TEVAR MedicalManagementOnly

Evolution of BTAI management

Actuarial Survival

TEVAR for all? With same expediency?

Optimal management

evolving….

Sandhu HK, et al. – J Vasc Surg. 2017 Sep 22

Spencer SM, et al. – J Trauma Acute Care Surg. 2017 June 20.

Harris DG, et al. - J Vasc Surg. 2016 Aug;64(2):500-505

Gandhi SS, et al. – J Vasc Surg. 2016 Dec;64(6):1580-1586

Harris DG, et al. – Ann Vasc Surg. 2016 Aug;35:75-81

Heneghan RE, et al. – J Vasc Surg. 2016 Jul;64(1):171-6

Fortuna GR, Jr. et al. – J Vasc Surg. 2016 May;63(5):1225-31

DuBose JJ, et al. – J Trauma Acute Care Surg. 2015 Feb;78(2):360-9

2014

aortictrauma.org

ATF - Mission Statement

To improve outcomes of patients with

traumatic aortic injury (TAI) through

education and research.

Structure:

Non-profit 501(c)(3) organization

Board of Directors

Multispecialty Medical Advisory Board

Education: Health Care Professionals

Pre-hospital:

EMT/Ambulance

Hospital:

ER nurses and physicians

Trauma service

Consultants:

Vascular surgeons

Thoracic surgeons

Radiologists

Cardiologists

Research efforts

Consortium of

trauma centers

International registry

for TAI patients

Multi-specialty

Clinical Practice

Guidelines

ATF – BTAI Multicenter Retrospective Study

9 ACS Level 1 trauma centers

2008-2013

N = 382 pts

J Trauma 2015

SVS Injury Grade

Grade I, n (%) 94 (24.6%)

Grade II, n (%) 68 (17.8%)

Grade III, n (%) 192 (50.3%)

Grade IV, n (%) 28 (7.3%)

Injuries Identified

Aortic Trauma Foundation Study Findings

Non-operative management (123 pts; 31.9%) = only 2 failures

Repair

Open = 61 (16%); TEVAR = 198 (51.8%)

TEVAR associated with:

Less PRBC required (Mean 3.1 vs. 5.9, p = 0.002)

Less FFP required (Mean 3.3 vs. 1.9, p = 0.021)

Lower overall mortality (8.6% vs. 19.7%, p = 0.021)

Lower aortic-related mortality (2.5% vs. 13.1%, p = 0.003)

Clinical Dilemma: SVS Grade I - II

No difference in outcomes for patients

treated with NOM vs. TEVAR for “Minimal

BTAI” (SVS Grade I – II injuries)

SVS presently suggests treatment for SVS

Grade II injuries

More investigation needed in this subgroup

BTAI - Contemporary Management

Society for Vascular Surgery (SVS)

American Association for the Surgery of Trauma (AAST)

Eastern Association for the Surgery of Trauma (EAST)

ATF International, Multicenter Prospective

BTAI Registry

Predictors of early rupture

Long-term outcomes

Establish natural history

Centralized, online data reporting

“Live” February 2016

aortictrauma.org

ATF - Regional Directors

Serve as ambassador for ATF

Promote regional participation in scientific studies

US - 11 Regional Directors

OUS - 10 Regional Directors

US Regions

Regions Regional Directors

Pacific Coast Elina Quiroga Karen Woo

Southwest Ramy Gilani

Southeast Ben Pearce

Mountain Chuck Fox

Heartland Todd Vogel Jerry Fortuna

Midwest Ross Milner

Appalachian Highlands

Josh Adams

Mid-Atlantic Megan Brenner

New England Andy Schanzer

OUS Regions

Regions Regional Directors

Canada Chad Ball Neil Parry Joao Rezende-Neto

Jason Faulds

Europe Tal Hörer Victor Reva Vincent Riambau Roberto Chiesa

Asia Boris Kessel Junichi Matsumoto

BTAI registry – February 2018 update

139 patients; 17 Centers

Internationally

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