Choice of treatment comparing open vs endovascular repair of traumatic thoracic aortic injury

We suggest that endovascular repair be performed preferentially over open surgical repair or nonoperative management (Grade 2, Level C).

Values

Endovascular repair should be performed preferentially over open surgical repair or nonoperative management, the committee placed a significantly higher value on preventing catastrophic complications of thoracic aortic repair (death, stroke, and spinal cord ischemia) and a lower value on potential adverse events such as endoleak, need for reintervention, and device failures. The committee also placed less value on possible late-term outcomes that remain unknown at this time. Furthermore, the committee acknowledges the off-label use of a medical device in the context of endovascular repair of traumatic thoracic aortic injury, although there are ongoing studies investigating the safety and efficacy in this application; however, as we believe that preventing death is paramount in this setting, the committee recommends endovascular repair.