Unmet needs in the management of traumatic aortic injury

Blunt traumatic aortic injury (BTAI) is a rare, but highly lethal, traumatic injury. Accruing data suggests that grade I and likely grade II injuries can safely be managed with medical therapy, while high-grade injuries (III, IV) require operative repair. Endovascular technology has largely supplanted open repair as first-line operative intervention. However, the complexity of the blunt trauma patient makes management decisions less than straightforward. Competing injury priorities, contraindications to anti-impulse therapy and anticoagulation therapy complicate decision-making in the management of BTAI. The development and implementation of a consensus grading system and treatment algorithm for the management of BTAI is necessary and will require multi-institutional study.