Update Course Rewind: Vascular Trauma Management 2024

This topic falls into the black diamond category of unproven approaches.

Thoracic aortic injury is very, very rare in children.

In a national survey, about 67% of pediatric thoracic aortic injuries were managed non-operatively, 27% were managed endovascularly, and 6% were managed open.

Endovascular repair has been shown to have better outcomes than non-operative management for pediatric thoracic aortic injuries.

Endovascular repair may be a better treatment option for children with thoracic aortic injuries because they may progress.

At some institutions it is not totally consistent which service (cardiac surgeons, vascular surgeons, or IR) manages pediatric thoracic aortic injuries.

Some thoracic aortic injuries can be missed when the patient first arrives at the ER.

Thoracic aortic injuries can be missed in children because children are really small, and if they have a little intimal tear, it may not be visible on initial scan review.

To catch possible thoracic aortic injuries, order CT chest scans in patients whose chest x-rays show a wide mediastinum.

If there is mediastinal widening on chest x-ray, that is a concern for some kind of great vessel injury that definitely needs a CTA of the chest.

A 10 year review shows TVAR (thoracic endovascular aortic repair) is very safe in children.

TVAR decreases mortality compared to other management approaches for pediatric thoracic aortic injury.

TVAR decreases risk of spinal cord injury compared to open procedure for thoracic aortic injury.

TVAR gets pediatric patients out of the hospital faster than other management approaches for thoracic aortic injury.

There are really small stents available that can be used for TVAR in children.

According to adult SVS (Society for Vascular Surgeons) recommendations, endovascular repair would be 100% indicated for a 16-year-old with thoracic aortic injury.

Younger children with thoracic aortic injury were more likely to be managed non-operatively.