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Mortality can reach 80–90% at the scene and up to 46% in hospital, making timely diagnosis and management critical. 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Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.  \n1 Vascular Surgery Unit, Ospedale Giuseppe Mazzini, 64100 Teramo, Italy  \n2 Vascular Surgery Unit, Ospedali Riuniti Torrette, 60126 Ancona, Italy  \n* Correspondence: [ilenia.disario@aslteramo.it](ilenia.disario@aslteramo.it)  \nAbstract  \nBackground/Objectives: Blunt traumatic thoracic aortic injury is a rare but often fatal condition, typically resulting from high-energy deceleration mechanisms such as motor vehicle collisions or falls from height. Mortality can reach 80–90% at the scene, with in-hospital mortality up to 46% . Early diagnosis and appropriate management are essential to improve outcomes. Methods: We retrospectively analyzed 45 patients (29 males, 16 females) with varying degrees of aortic isthmus injury treated between January 2007 and December 2024 at two Italian vascular surgery centers. Aortic lesions were graded 0–3, with 40 patients undergoing thoracic endovascular aortic repair. Procedures utilized Gore TAG or Medtronic Valiant endografts. Perioperative management included controlled hypotension and left subclavian artery coverage was performed when necessary. Results: Procedural success was achieved in all patients (100%), with one type II endoleak. No perioperative complications or spinal cord ischemia were observed. Coverage of the left subclavian artery was required in 28.9% of cases. Thirty-day mortality was 9%, with no deaths directly attributable to aortic injury. Postoperative CTA confirmed adequate endograft placement in all patients. Conclusions: Endovascular repair is a safe and effective approach for BTAI, with excellent short-term outcomes. Management should be tailored to injury severity and patient comorbidities, with ongoing vigilance for spinal cord ischemia.  \nKeywords: blunt traumatic thoracic aortic injury; TEVAR; cerebrospinal fluid drainage  \n1. Introduction  \nBlunt traumatic thoracic aortic injury (BTAI) represents the second leading cause of death from blunt trauma after head injury [1] . It is associated with 80–90% mortality at the accident scene [2] . Of those reaching the hospital, mortality can still reach 32% within the first 24 h, with about one-third of cases dying before surgical repair can be performed [3–5] . The overall incidence of BTAI ranges between 1.5% and 2% among patients admitted for chest trauma [6] .  \nMost injuries result from car accidents (70%), followed by motorcycle crashes (13%) and falls from height (7%) . However, only about 1% of patients involved in motor vehicle collisions present with BTAI. These data may be underestimated, as they do not include patients who die at the scene [7] .  \nBTAI mainly occurs at the level of the aortic isthmus, although the underlying reason still remains incompletely understood.  \nRegardless of the proposed mechanisms, aortic injury develops in two stages: rupture of the intima and media, followed by disruption of the adventitia. The damage may be partial or circumferential.  \nBTAI can be classified into four types [1]:  \n1. Type I: intimal tear  \n2. Type II: intramural hematoma  \n3. Type III: pseudoaneurysm  \n4. Type IV: rupture  \nThe clinical symptoms are nonspecific and depend on lesion severity. Patients with low-grade injuries may be asymptomatic or may present with retro-scapular pain; more severe cases can manifest with hemorrhagic shock.  \nClinical signs may include chest wall injury, pseudo-coarctation syndrome, a systolic murmur, or p","cbCaianYneFsTW8g","https://ap.wps.com/l/cbCaianYneFsTW8g","pdf",592963,"English","# Introduction\n## Epidemiology and mechanisms\n## Pathophysiology and classification\n## Clinical presentation and diagnostic approach\n## Imaging with CTA and transfer to trauma centers\n## Timing of intervention and nonoperative management","[{\"question\":\"What is the clinical significance of blunt traumatic thoracic aortic injury (BTAI)?\",\"answer\":\"BTAI is a rare but highly lethal injury after blunt trauma, with very high mortality both at the scene and during initial hospitalization. Early recognition and appropriate treatment are essential to improve survival.\"},{\"question\":\"How was the study designed and who were the patients?\",\"answer\":\"The study retrospectively analyzed 45 patients with aortic isthmus injury treated between January 2007 and December 2024 at two Italian vascular surgery centers. Aortic lesions were graded 0–3, with thoracic endovascular aortic repair performed in 40 patients.\"},{\"question\":\"What were the main outcomes after endovascular repair?\",\"answer\":\"Procedural success was reported in all patients (100%), with one type II endoleak and no perioperative complications or spinal cord ischemia observed. Thirty-day mortality was 9%, and postoperative CTA confirmed adequate endograft placement.\"}]","Endovascular Repair of Blunt Aortic Trauma - A Multidisciplinary Approach and a Retrospective Multicenter Study | PDF",1790761860]