Embolization in Trauma: Review of Basic Principles and Techniques

Lopera, Jorge E.

doi:10.1055/s-0041-1724015

Cited by 15 publications

(14 citation statements)

References 41 publications

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“…In this setting, it is widely acknowledged that the embolic choice should be at the discretion of the operator. 23 However, regression analysis in this study showed that the use of a non-selective embolisation technique was significantly protective of mortality, and non-selective embolisation was used significantly more in unstable patients in our cohort. Both selective and nonselective embolisation have been shown to be effective in pelvic haemorrhage management, and the use of either is generally at operator discretion.…”

Section: Discussioncontrasting

confidence: 53%

“…In assessing the type of treatment given to patients, the type of embolic agents used in this study varied between an even mix of gelatin sponge, coils, or a combination of the two. In this setting, it is widely acknowledged that the embolic choice should be at the discretion of the operator 23 . However, regression analysis in this study showed that the use of a non‐selective embolisation technique was significantly protective of mortality, and non‐selective embolisation was used significantly more in unstable patients in our cohort.…”

Section: Discussionmentioning

confidence: 58%

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A retrospective observational study assessing mortality after pelvic trauma embolisation

Clements,

Dunne,

Clare

et al. 2024

J Med Imag Rad Onc

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IntroductionTrauma to the pelvic ring and associated haemorrhage represent a management challenge for the multidisciplinary trauma team. In up to 10% of patients, bleeding can be the result of an arterial injury and mortality is reported as high as 89% in this cohort. We aimed to assess the mortality rate after pelvic trauma embolisation and whether earlier embolisation improved mortality.MethodsRetrospective study at single tertiary trauma and referral centre, between 1 January 2009 and 30 June 2022. All adult patients who received embolisation following pelvic trauma were included. Patients were excluded if angiography was performed but no embolisation performed.ResultsDuring the 13.5‐year time period, 175 patients underwent angiography and 28 were excluded, leaving 147 patients in the study. The all‐cause mortality rate at 30‐days was 11.6% (17 patients). The median time from injury to embolisation was 6.3 h (range 2.8–418.4). On regression analysis, time from injury to embolisation was not associated with mortality (OR 1.01, 95% CI 0.952–1.061). Increasing age (OR 1.20, 95% CI 1.084–1.333) and increasing injury severity score (OR 1.14, 95% CI 1.049–1.247) were positively associated with all‐cause 30‐day mortality, while non‐selective embolisation (OR 0.11, 95% CI 0.013–0.893) was negatively associated.ConclusionThe all‐cause mortality rate at 30‐days in or cohort was very low. In addition, earlier time from injury to embolisation was not positively associated with all‐cause 30‐day mortality. Nevertheless, minimising this remains a fundamental principle of the management of bleeding in pelvic trauma.

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Section: Discussioncontrasting

confidence: 53%

Section: Discussionmentioning

confidence: 58%

A retrospective observational study assessing mortality after pelvic trauma embolisation

Clements,

Dunne,

Clare

et al. 2024

J Med Imag Rad Onc

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“…For patients with ongoing arterial bleeding from pelvic fractures angiographic embolization can be used [Wong and Bucknill, 2017]. Embolization is a procedure to control bleeding in a particular area by using a catheter to access the effected blood vessel and use either a balloon or haemostatic agents to partially block the vessel to control bleeding [Lopera, 2021]. This can be used as a first line intervention in haemodynamically unstable pelvic ring injuries [NICE, 2017].…”

Section: Embolizationmentioning

confidence: 99%

“…This can be used as a first line intervention in haemodynamically unstable pelvic ring injuries [NICE, 2017]. Angiography is when a contrast is inserted into blood vessels under X ray so that the site of bleeding in a particular blood vessel can be located [Lopera, 2021]. It cannot be used to treat arterial bleeding from multiple sources [Parry et al 2020].…”

Section: Embolizationmentioning

confidence: 99%

Assessment and management of pelvic fractures from high-energy trauma in adults

Charsley

Jarman

2023

Emergency Nurse

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Pelvic fractures caused by high energy trauma such as falling from a height or road traffic collisions have a high mortality rate and many patients are left with life changing and debilitating injuries. High energy fractures to the pelvis can be associated with major haemorrhage and injuries to internal organs in the pelvis [Vaidya et al 2016]. Emergency nurses have a fundamental role in caring for these patients and the nurse assessment and management of the patient in the acute phase is important to improve the patient's overall outcome. This article focuses on the anatomy of the pelvis, initial assessment and management of patients presenting with high-energy pelvic fractures and complications associated with pelvic fractures.

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“…However, arterial injury may still produce a blush, and angioembolization of arterial source of bleeding may then be pursued for hemorrhage control. A strategy of selective or supra-selective embolization techniques to the injured vessels may be used [ 23 , 24 ], but more centrally located or named vessels should be avoided for total occlusion and subsequent ischemia. Given the dual supply by the liver (portal and arterial), even extensive embolization may be well tolerated.…”

Section: Adjunct Role Of Angioembolization To Operative Managementmentioning

confidence: 99%

Management of severe liver injuries: push, pack, pringle – and plug!

Kanani

Sandve

Søreide

2021

Scand J Trauma Resusc Emerg Med

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Rupture of the liver is fortunately an accident not often met with, but one which, when it is seen, may be associated with a condition of the patient as serious as anyone can meet within surgical practice" [1].These are the introductory words of the article by the Glasgow surgeon J. Hogart Pringle, written over a century ago, that would describe the clinical and experimental attempt at surgical control of severe liver lacerations by means of clamping the vessels in the hepatoduodenal ligament [1]a procedure since referred to by the eponymous "Pringle's manoeuvre" (Fig. 1). Notably, Pringle himself noted in his seminal paper that in severe cases of bleeding the only right thing to do was to pack. Hence, the surgical dogma for managing severe bleeding of the liver has been to Push (to approximate the rough wound-edges towards each other for compression), Pack (to ensure tight packing and compression of the liver parenchyma) and Pringle (to temporize and reduce the inflow of the portal vein and hepatic artery to the liver). This surgical dogma has been taught for decades, yet with high mortality rates for patients suffering severe hepatic lacerations and bleeding. However, since the emergence and widespread use of cross-sectional imaging by computed tomography in the 1980s and 1990s, the emergence of nonoperative management has slowly and steadily increased for all solid organ injuries [2][3][4]. Added to this is the increased understanding of injury pathophysiology and haemodynamics with appropriate resuscitation measures [5,6], better organized trauma care and structured team training [7], and

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Embolization in Trauma: Review of Basic Principles and Techniques

Cited by 15 publications

References 41 publications

A retrospective observational study assessing mortality after pelvic trauma embolisation

A retrospective observational study assessing mortality after pelvic trauma embolisation

Assessment and management of pelvic fractures from high-energy trauma in adults

Management of severe liver injuries: push, pack, pringle – and plug!

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