SVS Releases Clinical Practice Guideline on the Management of Blunt Thoracic Aortic Injury

Updated guidance incorporates new research to address nonoperative management of BTAI, timing of repair & managing patients with concomitant traumatic injuries.

ROSEMONT, IL, UNITED STATES, March 24, 2026 /EINPresswire.com/ -- The Society for Vascular Surgery (SVS) has released an updated clinical practice guideline on the Management of Blunt Thoracic Aortic Injury (BTAI), providing 13 updated recommendations based on the latest published evidence in the management of BTAI since the prior publication in 2011.

“Dedicated guidelines for blunt thoracic aortic injury are critically important because it remains one of the most lethal injuries in trauma care and demands rapid, evidence-informed decision-making,” said Ali Azizzadeh, MD, chair of the guideline writing group and Professor and Director of Vascular Surgery at Cedars-Sinai Medical Center in Los Angeles, CA. “This focused update translates more than a decade of new data into practical recommendations to guide contemporary practice while also identifying important gaps that require further research.”

Although rare, BTAI is a potentially life-threatening complication of major trauma, most often resulting from events such as motor vehicle collisions, pedestrian strikes or falls. Patients with BTAI frequently have multiple related injuries, including traumatic brain injury (TBI), solid organ injury (SOI) and pelvic fractures, which significantly increases the risk of hemorrhagic complications and makes management more complex.

These associated injuries often take precedence over initial BTAI management, making timely diagnosis and close coordination among trauma and vascular specialists essential.

In updating the guidelines, SVS brought together a multidisciplinary panel of experts that included members of the Aortic Trauma Foundation. “It is my hope that these updated guidelines will help guide the multidisciplinary teams charged with caring for these patients, both improving the quality of care and helping to establish areas of future investigation,” said Peter Rossi, MD, Secretary, Aortic Trauma Foundation.

What the new guidelines recommend

The updated guideline includes recommendations addressing when surgery is necessary, when non-operative management is appropriate, how patients should be monitored and how to manage complex cases involving additional traumatic injuries. Some key recommendations are:

Non-operative management for Grades 1 and 2 BTAI (minimal aortic injury, MAI): In patients with Grades 1 and 2 BTAI (minimal aortic injury, MAI), SVS recommends definitive non-operative management (NOM) over Thoracic Endovascular Aortic Repair (TEVAR) or open repair (OR). Grade 1 injuries require no routine follow-up imaging. Grade 2 injuries should undergo one follow-up CTA to assure resolution.

Timing of repair in Grade 3 injuries: In patients with hemodynamically stable Grade 3 BTAI, SVS suggests delayed TEVAR (>24 hours) to allow for management of other associated traumatic injuries if needed. In an unstable patient where there is a concern that the BTAI is the specific cause for the patient’s instability, SVS recommends urgent (<24 hours) or emergent intervention.

Management of patients with concomitant traumatic brain or solid organ injury: In patients with Grades 1 or 2 BTAI and concomitant TBI, anti-impulse therapy is not recommended, and blood pressure management should prioritize TBI over BTAI. For Grade 3 injuries with TBI or solid organ injury (SOI), decisions regarding anti-impulse therapy and timing of TEVAR should be individualized and made collaboratively with other stakeholders, including trauma and neurosurgery. Emergent repair is recommended for Grade 4 injuries. For patients with BTAI and concomitant TBI or solid organ injury, SVS suggests a collaborative approach for intraprocedural anticoagulation during TEVAR.

The full guideline is now available in the Journal of Vascular Surgery.

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About SVS

The Society for Vascular Surgery (SVS) seeks to advance excellence and innovation in vascular health through education, advocacy, research, and public awareness. The organization was founded in 1946 and currently has a membership of approximately 6,500. SVS membership is recognized in the vascular community as a mark of professional achievement.

Megan Marcinko
Society for Vascular Surgery
svspress@vascularsociety.org

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