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a) A patient with vasculitic hepatic artery aneurysms presented following minor trauma. Axial contrast enhanced CT demonstrates haematoma around a pseudoaneurysm (arrow) indicating that this is the likely cause of recent haemodynamic instability. b) 3D volume rendered reconstruction demonstrates 3 aneurysms arising from a branch of the left hepatic artery (arrows). The right hepatic artery arose from the SMA. c) Selective arteriogram of the coeliac axis with standard catheter after 2 aneurysms had been embolised with onyx (ev3, Irvine, CA, USA). The cast of the onyx is demonstrated, and some distal embolisation (arrow) of onyx. d) A microcatheter is demonstrated within the final bleeding aneurysm (arrow). e) A selective angiogram demonstrates onyx filling all aneurysms and maintained patency of the gastroduodenal artery.
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Over the past twenty years there has been a shift towards non-operative management (NOM) for haemodynamically stable patients with abdominal trauma. Embolisation can achieve haemostasis and salvage organs without the morbidity of surgery, and the development and refinement of embolisation techniques has widened the indications for NOM in the manage...
Contexts in source publication
Context 1
... the point of injection it will follow even tiny vessels distally to fill a pseudo aneur- ysm and continue on beyond, shutting both front and back doors without necessitating manipulation through the lesion with a microcatheter and wire. Figure 2 demonstrates embolisation of multiple hepatic artery aneurysms with onyx. ...Similar publications
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Background/Aims:
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Citations
... During the initial resuscitation of trauma patients, intraabdominal organ bleeding can be diagnosed rapidly using sonography to perform a focused assessment of the trauma [12][13][14]; however, in the case of kidney injury, early diagnosis is difficult because of the anatomical location of the kidney. Advances in CT imaging and embolization have enabled a high success rate detecting the location and nonsurgical treatment of bleeding in cases of damage to solid abdominal organs such as the liver and spleen [15][16][17]. The accumulation of skill in nonsurgical treatment of solid organs has made it possible to change the treatment paradigm from surgical (performing a nephrectomy) to conservative treatment of renal injury. ...
Purpose: Renal injury occurs in up to 5% of trauma cases and the kidney is the third most wounded abdominal organ. The study objective was to analyze clinical characteristics of patients with blunt renal trauma and review the treatment of high-grade blunt renal injuries.Methods: The medical charts of trauma patients who visited Haeundae Paik Hospital between March 2010 and February 2020 were retrospectively analyzed. Data on demographics, injury patterns, clinical presentation, management, and outcomes were analyzed.Results: A total of 68 patients with renal trauma were included in this study. The most common renal injury was Grade III ( n = 27, 39.7%). Falling was the predominant mechanism of injury ( n = 33, 48.5%), and 23.5% ( n = 16) of patients sustained isolated renal trauma. Organ damage related to kidney injury included chest injury (57.4%, n = 39) and abdominal or pelvic content injury (48.5%, n = 33). The overall mortality rate was 2.9% ( n = 2). There were 45 cases of high-grade renal trauma (AAST Kidney injury scale Grade Ш-V). There was no statistical difference in the outcomes of high-grade ( n = 44, 97.8%) and low-grade ( n = 23, 100%) renal trauma patients who received nonoperative treatment ( p = 0.511). Variables did not differ significantly, except for the injury severity score which was statistically significantly different between low-grade and high-grade renal trauma patients ( p = 0.001).Conclusion: Most patients with traumatic renal injury, even those with high-grade injury, can be managed by nonoperative treatment, and have a good prognosis.
... High clinical success rates were previously reported with angioembolization in solid organ trauma and pelvic injuries (79.8%, 88.0%, 90.9%, and 91.7% for liver, spleen, renal, and pelvic injuries, respectively) [3] with IR use becoming established in both hemodynamically stable and unstable trauma patients [7][8][9]. Although multidetector computed tomography (MDCT) is the gold standard procedure in detecting vascular injuries, there is still need for diagnostic angiography when there is high clinical suspicion of bleeding with no extravasation on CT [10]. Angiography and embolization are thus considered essential elements in both diagnosis and management protocols of trauma patients. ...
Introduction:
Interventional angiography is increasingly utilized in trauma management for various injuries. Despite published guidelines by the Eastern Association for the Surgery of Trauma on the use of angiography, limited data exist on factors associated with outcomes in angiography procedures. This study examines factors associated with survival to hospital discharge in trauma patients undergoing angiography with or without embolization across US trauma centers.
Materials and methods:
This retrospective observational study used the National Trauma Data Bank 2017 dataset and included adult trauma patients who underwent conventional angiography with or without embolization. A bivariate analysis was done to compare patients' characteristics by outcome (survived/died), followed by a multivariable logistic regression analysis to determine factors associated with survival to hospital discharge after adjusting for important confounders.
Results:
In the included sample of 4242 patients, median age was 41 years and male gender was predominant (72.6%). Overall mean time to angiography was 263.77 ± 750.19 min. Factors positively associated with survival included treatment at large facilities with over 401 beds (OR = 2.170; 95% CI, [1.277-3.685]), helicopter ambulance/fixed-wing transport (OR = 1.736; 95% CI, [1.325-2.275]), mild Glasgow Coma Scale (OR = 7.621; 95% CI, [5.868-9.898]) and moderate Glasgow Coma Scale (OR = 3.127; 95% CI, [2.080-4.701]), SBP ≥ 90 (OR = 1.516; 95% CI [1.199-1.916]), and spleen as embolization site (OR = 1.647; 95% CI [1.119-2.423]).
Conclusion:
This nationwide study identified variables associated with survival in trauma patients who underwent angiography. These variables can serve in creating standardized risk stratification tools that could be incorporated into evidence-based guidelines for angiography candidates.
... [2] Even though MDCT has high accuracy in detecting vascular injuries, the need for diagnostic angiography is still present when there is high clinical suspicion with negative CT findings. [4] Moreover, angiography is the modality of choice for therapeutic intervention such as embolization, ensuring vascular patency or inserting intravascular devices [2] with high clinical success rate of angioembolization for liver, spleen, renal, and pelvic injuries (79.8%, 88%, 90.92%, and 91.75% respectively). [2] Most guidelines on the use of IR in the treatment of traumatic injury have been based on observational studies and case series, however to date there are no studies that describe IR utilization and characteristics of patients across trauma centers in United States. ...
Angiography and embolization are part of trauma management protocols for various injuries. This study examines the use of
angiography and embolization use in trauma care across Trauma Centers in the United States.
We used the National Trauma Data Bank (NTDB) 2017 dataset in this retrospective observational study. Adult trauma patients
(≥16 years) who underwent conventional angiography with or without embolization were included. A univariate analysis was
carried out to describe patients’ demographic and injury characteristics as well as the time to angiography, angiography details,
complications, and outcome (survival to hospital discharge: yes/no). One-year period prevalence proportion of angiography
procedure was determined.
A total of 4242 patients were included. The 1-year period prevalence proportion of angiography procedure with or without
embolization was 0.53% (95% confidence intervals: 0.527–0.529). The median age was 41 years (interquartile range: 27–58) with
most patients being in the age group 16 to 64 (83.8%) and males (72.6%). Over half of the patients, 55.4% had an embolization
procedure performed in addition to angiography. The mean time to angiography was 263.77 ± 750.19 minutes. The most common
embolization sites were the pelvis (24.9%), spleen (11.8%), and liver (9%).
This study described angiography and embolization utilization in adult trauma patients in Trauma Centers in the US. Its findings
provide the basis for future studies to examine more closely angiography/embolization utilization in specific subpopulations, and
to create standardized risk stratification tools for trauma patients who are candidates for this procedure.
... None of the other included studies announced any procedure-related complications or lack of information on this. from 77 to 96% [24][25][26][27]. Similarly, we found that the procedure exhibited a very high clinical success rate for the selected hemodynamically unstable patients (97%). ...
Purpose
The objective of the present study is to provide a comprehensive review of the literature on associated outcomes of angioembolization in blunt abdominal solid organ traumas.
Methods
The databases of Medline, Embase, and Cochrane Library were explored until 24 September 2021. All studies with data on the efficacy or safety of angioembolization in patients suffering from hemodynamically unstable blunt abdominal solid organ trauma were included. The primary outcomes were clinical success rate and mortality. Pooled event rates were calculated using a double arcsine transformation to stabilize the variance of the original proportion.
Results
In total, 13 reports of 12 studies were included in the systematic review. According to the current meta-analysis, the angioembolization for blunt abdominal solid organ trauma in hemodynamically unstable patients had a high clinical success rate [0.97 (95% CI 0.93–0.99)] and low mortality [0.03 (95% CI 0.01–0.07)]. Furthermore, no statistically significant difference was found between the various injured solid organs for either of these parameters. In addition, the technique-associated adverse events were seldom and tolerable.
Conclusions
For blunt abdominal solid organ trauma in hemodynamically unstable patients, this review shows that angioembolization exhibited a high clinical success rate, low mortality, and tolerable technique-related adverse events. Furthermore, the top possible indication for angioembolization in hemodynamically unstable patients is an individual who responds to rapid fluid resuscitation. However, high-quality and large-scale trials are needed to confirm these results and determine the selection criteria for appropriate patients in this setting.
... Regardless of whether selective or nonselective embolization included abdominal and/or pelvic embolizations, selective embolization was defined as follows, based on previous reports: 9,10 selective embolization for the pelvis was the embolization of branches of the internal or external iliac arteries, 9 and selective embolization of the abdomen was embolization of the segmental branches of an organ artery, such as liver, splenic, and renal arteries. 10 The statistical significance of all tests was set using a two-tailed P-value of less than 0.05. All analyses were undertaken using statistics software (R version 4.0.3; ...
Aim:
Limited information exists on the factors associated with prolonged procedural time in embolization for trauma patients. We clarified the clinical application of embolization in trauma patients and factors associated with a prolonged procedure time.
Methods:
Medical records of 162 trauma patients who underwent embolization between January 2007 and December 2020 at a regional trauma care center were reviewed retrospectively. Patients were divided into four embolized body regions: chest, abdomen, pelvis, and other. Patient demographics, trauma mechanism, physiology, trauma severity, embolization procedures, and 30-day mortality were examined. The outcomes were identifying an embolized body region, embolized arteries, and procedure time. Multiple regression model was created to investigate the factors associated with prolonged procedural time in embolization.
Results:
Embolization was mainly undertaken in pelvic fractures (n = 96, 59%) and abdominal organ injuries (n = 57, 35%) and extended to the chest (n = 17, 10%), and other (n = 20, 12%). Approximately 13% (n = 21) of patients underwent embolization in two or more regions. Embolization was more strictly performed in minor artery injuries, for example, external iliac (n = 15, 16%) and lumbar artery (n = 22, 23%) branches in pelvic fractures, and inferior phrenic artery (n = 2, 3.5%) branches in liver injuries. Multiple regression model indicated that the number of embolized arteries (P = 0.021) and number of embolized regions (P < 0.001) were associated with prolonged procedural time in embolization.
Conclusions:
Embolization for trauma patients extended to various trauma regions. In time-sensitive embolization, emergency interventional radiologists showed superior knowledge of expected embolizing arteries and factors associated with procedure time.
... While some operating rooms (ORs) and angiography suites may come equipped with flat panel C-arm CT capabilities, inroom MDCT scanners allow for acquisition of multi-phase, diagnostic level imaging of nearly the entire patient's body, without image cut-off, a major limitation of cone beam CT [9,10]. The hybrid CT/C-arm system combines a flat-panel detector with a sliding gantry system, thereby allowing for safe and time efficient transitions between modalities without having to physically transfer the patient [11]. ...
Access to multi-detector computed tomography (MDCT) scanning for interventional procedures can prove to be logistically challenging as resources are often in different areas within the hospital. At some institutions, interventional radiology suites have moved to the operating room, separate from the diagnostic radiology department. At these institutions, complex interventional procedures requiring both fluoroscopy and MDCT may pose logistical challenges, especially as they pertain to timely patient transfers. Hybrid CT/fluoroscopy suite provides rapid, reliable MDCT assessment of trauma patients before and after emergent surgery, as well as access to the entire spectrum of emergent image-guided interventions in the same suite.
... In addition, the association between selective embolization or non-selective embolization and procedure time was assessed, especially for pelvic fractures and abdominal organ injuries. Regardless of whether selective or not selective embolization included abdominal and/or pelvic embolizations, selective embolization was de ned as follows based on the previous literature 6, 7 : selective embolization for the pelvis was the embolization of branches of the internal or external iliac arteries 6 ; and selective embolization of the abdomen was embolization of the segmental branches of an organ artery, such as liver, splenic, and renal arteries 7 . The statistical signi cance of all tests was set using a two-tailed p-value of < 0.05. ...
Objectives
Limited information exists on embolization for trauma patients regarding arteries embolized, embolic materials used, and embolization duration. We clarified the clinical application of embolization in trauma patients and factors associated with a prolonged procedure time.
Methods
Medical records of 162 trauma patients who underwent embolization between January 2007 and December 2020 at a regional trauma care center were reviewed retrospectively. Patients were divided into six embolized body regions: cerebrovascular, chest, abdomen, pelvis, peripheral, and other. Patient demographics, trauma mechanism, physiology, trauma severity, embolization procedures, and 30-day mortality were examined. The primary outcome was identifying an embolized body region and arteries, and secondary outcome was procedure time.
Results
Embolization was mainly performed in pelvic fractures (n = 96, 59%) and abdominal organ injuries (n = 57, 35%) and extended to the chest (n = 17, 10%), cerebrovascular (n = 8, 4.9%), peripheral (n = 5, 3.1%), and other (n = 7, 4.3%) regions. Approximately 13% (n = 21) of patients underwent embolization in ≥2 regions. Embolization was more strictly performed in minor artery injuries, e.g. external iliac (n = 15, 16%) and lumbar artery (n = 22, 23%) branches in pelvic fractures, and inferior phrenic artery (n = 2, 3.5%) branches in liver injuries. Non-selective embolization for a pelvic fracture tended to show a shorter procedure time despite no statistically significant difference (p = 0.056). For a longer procedure time, the number of embolized arteries (R = 0.357) and embolized body regions (R = 0.428) correlated.
Conclusions
Embolizations for trauma patients extended to various trauma regions. In time-sensitive embolization, emergency interventional radiologists showed superior knowledge of expected embolizing arteries and factors associated with procedure time.
... The treatment strategy of blunt injuries in solid organs including the liver is shifting from surgical to nonoperative management (NOM) in hemodynamically stable patients (13,(15)(16)(17)(18). ...
... In addition, interventional management has been widely used with high clinical success rates (15,16,19,20). In this article, we review the imaging features of liver injuries and focus on interventional management as a complement to NOM in the effective treatment of liver injuries and their complications. ...
Liver injury is a common consequence of blunt abdominopelvic trauma. Contrast-enhanced CT allows for the rapid detection and evaluation of liver injury. The treatment strategy for blunt liver injury has shifted from surgical to nonoperative management, which has been widely complemented by interventional management to treat both liver injury and its complications. In this article, we review the major imaging features of liver injury and the role of interventional management for the treatment of liver injury.
... Super selective transarterial embolization (SE) of injured vessels is an adjuvant method in the treatment of trauma patients and has broadened the spectrum of care to these patients. This technique can provide hemostasis in areas of difficult surgical access, providing non-surgical management of solid visceral lesions or isolated vascular lesions and quickly stop bleeding while preserve organ's function (Ptohis et al. 2017;Wallis et al. 2010;Ierardi et al. 2016). Moreover, compared to the open surgery, embolization is associated to reduced physiological stress, reduced blood transfusions and volume resuscitation, and reduced mortality rates (Wallis et al. 2010;Ierardi et al. 2016;Coccolini et al. 2017). ...
... This technique can provide hemostasis in areas of difficult surgical access, providing non-surgical management of solid visceral lesions or isolated vascular lesions and quickly stop bleeding while preserve organ's function (Ptohis et al. 2017;Wallis et al. 2010;Ierardi et al. 2016). Moreover, compared to the open surgery, embolization is associated to reduced physiological stress, reduced blood transfusions and volume resuscitation, and reduced mortality rates (Wallis et al. 2010;Ierardi et al. 2016;Coccolini et al. 2017). ...
... The management of splenic lesions presents divergences in the different trauma centers around the world, which indicates a difficulty in the management of this type of lesion, being widely considered the non-surgical treatment. In most of the reviewed studies, the splenic lesion with embolization was treated using as embolic material metal spirals and PVA particles (Wallis et al. 2010;Ierardi et al. 2016;Raikhlin et al. 2008; Wahl et al. Clinical decompensation 4 (57,1) ...
Purpose:
An increasing number of polytraumatized patient presenting with active abdominal pelvic bleeding (APB) have been treated by endovascular selective embolization. However, reports on evaluate the efficacy, safety and complications caused by this technique have been limited. The aim of this study was to assess the safety and efficacy of embolization of APB using N-butyl cyanoacrylate glue (NBCA).
Materials and methods:
Single center retrospective study, that included consecutive 47 patients presenting with traumatic APB treated by embolization with NBCA between January 2013 and June 2019. The efficacy endpoint was defined as the absence of contrast extravasation immediately after procedure and clinical stabilization in the following 24 h after procedure. Clinical stabilization was defined as no rebleeding after embolization or the need for a surgical approach until the patient is discharged. Safety endpoint were any technical or clinical complications related to the embolization procedure.
Results:
The mean age of patients was 38.6 years (3-81), with a predominance of males (87.2%). The major causal factor of APB being involvement in a car accident, accounting for 68% of cases. Of the 47 cases, 29.8% presented pelvic trauma and the remaining (70.2%) presented abdominal trauma. The efficacy rate was 100%, while no complications related to the procedure were observed. The mortality rate was 14.8% (7/47) due to neurologic decompensation and other clinical causes.
Conclusion:
Endovascular embolization of traumatic abdominopelvic bleedings appear to be a highly safe and effective treatment, while avoiding emergent exploratory open surgeries.
... Therefore, TAE is the standard treatment for controlling hemorrhage in blunt abdominopelvic trauma without shock and signs of peritonitis (3,4). In hypovolemic shock patients, open surgery is still considered the gold standard treatment for abdominopelvic trauma (5). However, several studies have reported that TAE is safe and effective for controlling hemorrhage in these settings (2, 6 -8). ...
Background
Transcatheter arterial embolization (TAE) is a useful endovascular technique for controlling hemorrhage in blunt abdominopelvic trauma without shock. However, several studies have reported that TAE is safe and effective for controlling hemorrhage in hypovolemic shock.
Objective
To evaluate the effectiveness of TAE for patients with shock from abdominopelvic trauma.
Method
The medical records of patients with abdominopelvic trauma at Her Royal Highness Princess Maha Chakri Sirindhorn Medical Center, Srinakharinwirot University from January 2014 to January 2019 were retrospectively reviewed. We enrolled patients with shock caused by injury to solid organs or pelvic fractures who underwent TAE.
Result
Of the 320 patients, 14 patients with shock underwent TAE. A total of 78.6% were male. The mean age was 37.5 years. The average injury severity score was 31.3. The most common mechanism of injury was traffic accidents (85.7%). Embolization was performed for 8 liver injuries, 5 pelvic fractures and 1 splenic injury. The treatment time for TAE was approximately 47.9 ± 33.2 min. The mean length of hospital stay was 21.3 ± 15.9 days. Two patients died (14.3%). There were no embolization-related complications. A significant improvement in systolic blood pressure (p = 0.028) and a decrease in heart rate (p = 0.001), lactate concentration (p = 0.011), and crystalloid fluid (p = 0.001) and blood transfusion requirements (p = 0.002) were observed after TAE.
Conclusions
TAE is a safe and effective method for treating shock patients with a rapid or transient response to resuscitation. For patients who are nonresponsive to resuscitation, TAE is an additional useful option for arterial hemorrhage control in abdominopelvic trauma.
