Clinical studyEmbolization for Multicompartmental Bleeding in Patients in Hemodynamically Unstable Condition: Prognostic Factors and Outcome
Section snippets
Materials and Methods
This retrospective study was approved by the local ethics committee, and a waiver for informed consent was obtained. Clinical and radiologic data were reviewed retrospectively from a prospective trauma registry, radiologic reports, and patient hospital charts. Relevant data were entered into a database on FileMaker Pro 9 software (FileMaker, Santa Clara, California).
Inclusion criteria were the following: polytrauma with hemodynamic instability, multiple bleeding sites, and treatment with
Results
The mean Injury Severity Score (ISS) was 49.4 ± 15.8. The mean New Injury Severity Score (NISS) was 50.6 ± 16. Active bleeding sites for each patient are shown in Table 2. The hemodynamic condition of patients at admission and at the time of transcatheter arterial embolization, as well as their outcomes, are shown in Table 3. Eight patients were receiving vasoactive drugs, with a mean norepinephrine dose of 26 μg/min.
Two patients required surgery before undergoing multidetector CT because of
Discussion
The present study was performed to evaluate the feasibility and outcomes of transcatheter arterial embolization in severely injured patients in hemodynamically unstable condition with polytraumatic injuries that included retroperitoneal bleeding associated with intrabdominal solid-organ injuries. Hemodynamic stabilization was achieved with transcatheter arterial embolization in 29 of 36 patients (80.5%). Additional hemostatic surgery had to be performed before or immediately after embolization
Acknowledgments
The authors thank Philippe Frascarolo for statistical analysis and advice.
References (42)
- et al.
Quality improvement guidelines for percutaneous transcatheter embolization: Society of Interventional Radiology Standards of Practice Committee
J Vasc Interv Radiol
(2010) - et al.
Traumatic occlusion and dissection of the main renal artery: endovascular treatment
J Vasc Interv Radiol
(2011) - et al.
Transcatheter arterial embolization of spontaneous life-threatening extraperitoneal hemorrhage
J Vasc Interv Radiol
(2011) - et al.
Balloon catheter tamponade in cardiovascular wounds
Am J Surg
(1990) - et al.
Nonoperative management of traumatic splenic injuries: is there a role for proximal splenic artery embolization?
AJR Am J Roentgenol
(2006) - et al.
Angioembolization reduces operative intervention for blunt splenic injury
J Trauma
(2008) - et al.
Nonoperative management of blunt splenic injury: a 5-year experience
J Trauma
(2005) - et al.
Improved outcome of adult blunt splenic injury: a cohort analysis
Surgery
(2006) - et al.
Clinical review: initial management of blunt pelvic trauma patients with haemodynamic instability
Crit Care
(2007) - et al.
Control of severe hemorrhage using C-clamp and arterial embolization in hemodynamically unstable patients with pelvic ring disruption
Arch Orthop Trauma Surg
(2005)
Arterial embolization is a rapid and effective technique for controlling pelvic fracture hemorrhage
J Trauma
Embolization of isolated lumbar artery injuries in trauma patients
Cardiovasc Intervent Radiol
Angiographic findings and embolotherapy in renal arterial trauma
Cardiovasc Intervent Radiol
The usefulness of transcatheter arterial embolization for patients with blunt polytrauma showing transient response to fluid resuscitation
J Trauma
Angioembolization and laparotomy for patients with concomitant pelvic arterial hemorrhage and blunt abdominal trauma
Langenbecks Arch Surg
Western Trauma Association (WTA) critical decisions in trauma: management of adult blunt splenic trauma
J Trauma
Shock: Advanced Trauma Life Support for Doctors: Student Course Manual
Evaluation of a single-pass continuous whole-body 16-MDCT protocol for patients with polytrauma
AJR Am J Roentgenol
Nonsurgical management of patients with blunt splenic injury: efficacy of transcatheter arterial embolization
AJR Am J Roentgenol
Cited by (14)
The effect of participation of interventional radiology team in a primary trauma survey on patient outcome
2022, Diagnostic and Interventional ImagingCitation Excerpt :Challenging IR procedures were first performed in hemodynamically unstable patients with ongoing retroperitoneal hemorrhage, including pelvic fracture or renal trauma [4–6]. Moreover, transcatheter arterial embolization (TAE) beyond the retroperitoneal cavity has been attempted in unstable patients, and two observational studies that examined TAEs and/or resuscitative endovascular balloon occlusion of the aorta for patients sustaining severe multiple trauma in hemodynamically unstable conditions have been published [7,8]. Although these two studies expanded the applicability of IR procedures, they could not demonstrate their survival benefit in these patients compared with conventional treatments [7,8].
Pediatric Anesthesia Outside the Operating Room: Case Management
2020, Anesthesiology ClinicsMultidisciplinary consensus document on the management of massive haemorrhage (HEMOMAS document)
2016, Revista Espanola de Anestesiologia y ReanimacionMultidisciplinary consensus document on the management of massive haemorrhage (HEMOMAS document)
2015, Medicina IntensivaRole of interventional radiology in trauma care: Retrospective study from single trauma center experience
2014, American Journal of Emergency MedicineCitation Excerpt :Traditionally, hemodynamically unstable patients have been taken straight to surgery rather than undergo CT or angiography to localize and treat hemorrhage. Bize et al [7] reported that IR, such as transcatheter arterial embolization, effectively controls bleeding and improves hemodynamic stability even in patients with unstable hemodynamic condition. In our series, even in patients who showed unstable hemodynamics, survival rate improved approximately 15%.
Pediatric abdominal and pelvic trauma: Safety and efficacy of arterial embolization
2014, Journal of Vascular and Interventional RadiologyCitation Excerpt :The number of PRBC units required before angiography was found to be a significant predictor of less favorable hemorrhage control. This is similar to results described in a recent adult trauma experience (3). One likely explanation is that PRBC transfusion may be an indicator of very extensive and/or rapid previous blood loss.
None of the authors have identified a conflict of interest.
This article includes figures and tables that are available online only at www.jvir.org.