Blunt Thoracic Aortic Injury Survey - Aortic Trauma Foundation

Blunt Thoracic Aortic Injury Practice Survey

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* 1. Which category best describes your profession?

Trauma Surgeon

Vascular Surgeon

Cardiothoracic Surgeon

Interventional Radiologist

Other (please specify)

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* 2. How many years have you been in practice (post-residency/fellowship)?

< 5 years

5-10 years

10 - 20 years

> 20 years

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* 3. In what region is your primary practice environment located?

North America

South America

Europe

Asia

Other (please specify)

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* 4. Which best describes your present practice environment?

Academic teaching facility

Community-based practice

Public / Government hospital

Military hospital

Other (please specify)

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* 5. What is the American College of Surgeons (ACS) trauma verification level of your primary practice environment?

ACS Level I

ACS Level II

ACS Level III

Non-ACS trauma center

I do not work at a trauma center

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* 6. What is the approximate volume of trauma admissions treated at your facility annually?

Less than 2,000

2,000 - 4,000

4,000 - 6,000

> 6,000

Unknown

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* 7. How many cases of blunt thoracic aortic injury (BTAI) are treated at your center each year?

None

1 - 5

6 - 10

11 - 15

16 - 20

> 20

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* 8. How many cases of blunt thoracic aortic injury (BTAI) do you PERSONALLY assist in the management of each year?

None

1 - 5

6 - 10

11 - 15

16 - 20

> 20

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* 9. What is the preferred imaging modality that you utilize to diagnose BTAI?

Computed tomographic angiography (CTA)

Traditional angiography

Echocardiography

Magnetic resonance imaging (MRI/MRA)

Intravascular ultrasound (IVUS)

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* 10. Once the diagnosis of BTAI has been made, what decision aid do you utilize to determine which patients require aortic repair?

Society for Vascular Surgery (SVS) guidelines

Institution specific guidelines

Personal knowledge of the literature and experience

Other (please specify)

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* 11. If presented with a hemodynamically stable patient with a confirmed ISOLATED BTAI SVS Grade I injury (intimal tear only), what is your primary treatment of choice?

Observation alone without medical therapy

Medical therapy / blood pressure control

Open repair

Thoracic Endovascular Aortic Repair (TEVAR)

Other (please specify)

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* 12. If presented with a hemodynamically stable patient with a confirmed ISOLATED BTAI SVS Grade II injury (intramural hematoma), what is your primary treatment of choice?

Observation alone without medical therapy

Medical therapy / blood pressure control

Open repair

Thoracic Endovascular Aortic Repair (TEVAR)

Other (please specify)

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* 13. If presented with a hemodynamically stable patient with a confirmed ISOLATED BTAI SVS Grade III injury (Pseudoaneurysm), what is your primary treatment of choice?

Observation alone without medical therapy

Medical therapy / blood pressure control

Open repair

Thoracic Endovascular Aortic Repair (TEVAR)

Other (please specify)

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* 14. If presented with a hemodynamically stable patient with a confirmed ISOLATED BTAI SVS Grade IV injury (rupture), what is your primary treatment of choice?

Observation alone without medical therapy

Medical therapy / blood pressure control

Open repair

Thoracic Endovascular Aortic Repair (TEVAR)

Other (please specify)

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* 15. If you select observation alone or medical therapy for a patient with BTAI, when do you repeat imaging (approximately)?

24 hours

48 hours

3 days

7 days

6 weeks

Other (please specify)

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* 16. What is your preferred imaging modality for follow-up of patients selected for observation alone or medical therapy?

Computed tomographic angiography (CTA)

Traditional angiography

Echocardiography

Magnetic resonance imaging (MRI/MRA)

Intravascular Ultrasound (IVUS)

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* 17. When medical management is selected as the treatment of choice for BTAI, do you target a goal Mean Arterial Pressure or a Mean Systolic Blood pressure?

Mean arterial pressure

Systolic blood pressure

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* 18. What is your blood pressure goal for medical therapy in the setting of BTAI?

MAP < 80 mm Hg

MAP < 100 mm Hg

SBP < 120 mm Hg

SBP < 100 mm Hg

Other (please specify)

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* 19. You are presented with an isolated BTAI that you elect to treat non-operatively. What associated injuries or imaging findings would cause you to change your treatment plan to repair (TEVAR or open repair)? (Select all that apply)

Associated mediastinal hematoma

Associated peri-aortic blood

Hemodynamic instability

Older patient age

Younger patient age

Significant co-morbidities

High overall injury severity

Need for other emergent operative procedures

Associated traumatic brain injury

Other (please specify)

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* 20. Who performs open repair, when needed, at your facility? (Select all that applyl)

Cardiothoracic surgeon

Trauma Surgeon

Vascular Surgeon

Other (please specify)

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* 21. Among patients requiring BTAI repair, what of the following would make you more likely to select OPEN repair? (Select all that apply)

Higher grade of BTAI

Lower grade of BTAI

Proximity of injury to the left subclavian artery

Presence of significant mediastinal hematoma on imaging

Presence of significant hemothorax on imaging

Length of aortic injury

Need for any other emergent surgical intervention

Need for emergent open thoracic surgery for indications other than BTAI

Overall injury burden / severity

Patient instability

Older patient age

Younger patient age

Patient co-morbidity – Renal Failure / Acute Renal Injury

Patient co-morbidity – Pulmonary disease / COPD

Experience level of providers available to conduct repair

Knowledge of local outcomes

Other (please specify)

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* 22. Among patients requiring OPEN repair of BTAI, which of the following approaches / adjuncts do you employ? (Select all that apply)

Left heart bypass

“Clamp and sew” technique

Spinal cerebrospinal fluid (CSF) drainage

Induced Hypothermia

Other (please specify)

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* 23. Who performs TEVAR at your facility? (select all that apply)

Vascular Surgeon

Cardiothoracic Surgeon

Trauma Surgeon

Interventional Radiologist

Interventional Cardiologist

Other (please specify)

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* 24. Among patients requiring BTAI repair, what criteria are indications for the selection of TEVAR (as opposed to open repair)?

Higher grade of BTAI

Lower grade of BTAI

Proximity of injury to left subclavian artery

Presence of significant mediastinal hematoma on imaging

Presence of significant hemothorax on imaging

Need for any other emergent surgical intervention

Length of aortic injury

Need for emergent open thoracic intervention for indications other that BTAI

Overall injury burden / severity

Patient instability

Older patient age

Younger patient age

Patient co-morbidity – Renal Failure / Acute Renal Injury

Patient co-morbidity – Pulmonary disease / COPD

Experience level of providers available to conduct repair

Knowledge of local outcomes

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* 25. Among patients requiring TEVAR for BTAI, which of the following approaches / adjuncts do you employ? (Select all that apply)

Percutaneous puncture for arterial access

Open vascular access exposure

Routine use of intra-operative angiography

Intravascular ultrasound

Induced hypothermia

Spinal cerebrospinal fluid (CSF) drainage

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* 26. When coverage of the left subclavian artery (L SCA) is required for TEVAR in the setting of BTAI, what is your role for undertaking (or requesting assistance to undertake) subsequent arterial bypass? (Select most appropriate response)

I do not utilize arterial bypass

I utilize either pre- or post-operative PLANNED bypass routinely

I utilized planned bypass selectively for only specific indications (i.e. known dominant left vertebral artery, PICA, or patent LIMA in post-CABG patient)

I utilized watchful waiting and selectively revascularize only if symptoms occur in the post-operative phase

I routinely utilize endovascular techniques (branch grafts, fenestrations) at the time of initial TEVAR to preserve L SCA flow in cases where main body graft coverage of the L SCA is required

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* 27. In your opinion, who should be conducting TEVAR for patients with BTAI? (select all that apply)

Interventional radiologists

Interventional cardiologists

Vascular Surgeons

Cardiothoracic Surgeons

Trauma Surgeons

Any provider with appropriate training should be able to conduct TEVAR

Other (please specify)

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* 28. How many TEVARs for BTAI conducted annually constitutes an adequate number to maintain proficiency?

1 - 2

3 - 5

6 - 10

> 10

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* 29. After TEVAR is completed, do you routinely perform dedicated follow-up imaging prior to discharge?

Yes

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* 30. If routine follow-up imaging prior to discharge is obtained, what type is utilized?

Not applicable

Plain radiography

Computed tomography

Echocardiogram

Magnetic resonance imaging (MRI/MRA)

Other (please specify)

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* 31. At what interval is follow-up imaging obtained prior to discharge?

Not applicable

3 days after TEVAR

7 days after TEVAR

Anytime prior to discharge

Other (please specify)

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* 32. Following discharge after TEVAR, when do you ideally recommend seeing the patient in follow-up?

1 week

2 weeks

4 weeks

3 months

6 months

Greater than 6 months

Other (please specify)

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* 33. What type of follow-up imaging do you utilized at the first clinical follow-up visit?

I do not obtain imaging at the first follow-up visit

Plain chest radiography

Echocardiogram

Computed tomographic angiography (CTA)

Magnetic resonance imaging (MRI/MRA)

Other (please specify)