Novel use of interventional radiology in trauma

Jeph, Sunil; Ahmed, Saif; Bhatt, Ruchika Dua; Nadal, Luis L.; Bhanushali, Ashok

doi:10.21037/jeccm.2017.10.04

Cited by 7 publications

(16 citation statements)

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“… 4 Emergent laparotomies are indicated in hemodynamically unstable patients or those who respond transiently to initial resuscitation. 4 In this study, a considerable proportion of patients were hemodynamically unstable, with hypotension as the main underlying cause, hemostasis to optimize the vital signs of these patients should be prioritized before PEAE. 9 , 11 , 13 …”

Section: Discussionmentioning

confidence: 99%

“…Selecting endovascular therapy or surgery for trauma management depends upon initial presentation, availability of facilities, hemodynamic status, trauma grade, response to initial therapy, imaging findings, and the interventional radiologists or surgeon’s judgment. 4 Currently, feasible PEAE are prioritized over surgery due to lower morbidity and mortality risks and the risk of large blood volume loss and uncontrolled vessel bleeding in surgery ( Table 3 ). 4 , 16 …”

Section: Discussionmentioning

confidence: 99%

“… 4 Currently, feasible PEAE are prioritized over surgery due to lower morbidity and mortality risks and the risk of large blood volume loss and uncontrolled vessel bleeding in surgery ( Table 3 ). 4 , 16 …”

Section: Discussionmentioning

confidence: 99%

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Predicting Suitable Percutaneous Endovascular Arterial Embolization for Traumatic Abdominopelvic Injuries: A Retrospective Cohort Study

Al-Sharydah¹

2022

OAEM

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Purpose This study evaluated the pre-procedural attributes of trauma patients to determine their suitability to undergo Percutaneous Endovascular Arterial Embolization (PEAE), and the current state of endovascular repair as an option for trauma-related injuries in traumatic abdominopelvic arterial injuries was explored. Patients and Methods We retrospectively evaluated the charts of 638 adults with traumatic abdominopelvic injuries treated from March 2011 to February 2021, extensively reviewing their pre-operative indices, pre-operative optimization requirements, and multi-modality imaging records. Results In total, 235 patients (30.63%) were “hemodynamically unstable” on admission, mainly due to hypotension (n=437 [68.5%]). Additionally, laboratory-defined acquired coagulopathies and inherited bleeding disorders were found in 268 patients (42.01%). The computerized tomography bleeding protocol was performed on 408 (63.94%) patients. Percutaneous endovascular therapy by arterial embolization was performed on 146 patients. The mean number of requested pre-intervention blood units for trauma patients significantly exceeded the number of units transfused post-intervention ( P <0.0005). Apart from hemodynamics (ie heart rate, mean blood pressure); hemoglobin, and lactic acid levels were independently associated indices of PEAE outcomes (p <0.01). Conclusion Despite the recommendations from the Society of Interventional Radiology on endovascular intervention for trauma and bleeding risk, 36.84% of study patients had hemodynamic instability and other unfeasible parameters that would limit the option of minimally invasive procedures. Early recognition and consideration of suitable treatment options is essential for optimizing patient outcomes. It is imperative that standardized algorithms and management protocols based on available resources be developed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Predicting Suitable Percutaneous Endovascular Arterial Embolization for Traumatic Abdominopelvic Injuries: A Retrospective Cohort Study

Al-Sharydah¹

2022

OAEM

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“…Deep dissection is usually required to achieve sufficient exposure and surgeons must be extremely vigilant and not disturb or damage surrounding structures during the procedure. Second, endovascular repair carries with it numerous technical advantages including remote access to precisely the desired location [12]. Even if the injury is not amenable to endovascular repair, a balloon catheter can be deployed as a temporizing measure until definite surgical repair can be performed [13].…”

Section: Discussionmentioning

confidence: 99%

Subclavian artery avulsion following blunt trauma: A case report and literature review

Elkbuli

Shaikh

McKenney

et al. 2019

International Journal of Surgery Case Reports

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Highlights Subclavian artery injuries are rare, highly fatal, and constitute less than 2% of all vascular injuries. Surgical repair of these injuries can be technically challenging due to their anatomic location. Therapeutic approaches include surgical repair, endovascular repair, or a hybrid approach depending on the severity of the injury and the patient’s hemodynamic status.

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“…These endovascular techniques can even allow for simultaneous diagnosis and intervention in peripheral vascular trauma and are especially useful in cases where sites of bleeding are difficult to access or identify. In the case of extremity trauma, endovascular interventions can Review Article achieve minimally invasive hemostasis whether it be by embolization or stent graft placement (6).…”

Section: Introductionmentioning

confidence: 99%

Endovascular interventions in the management of acute extremity trauma: a narrative review

et al. 2021

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Minimally invasive endovascular interventions including stenting and embolization have been widely adopted for the treatment of emergent and traumatic thoracoabdominal injuries. In recent years, these techniques have been utilized in the setting of extremity vascular trauma with promising outcomes. By allowing for the rapid diagnosis and subsequent treatment of penetrating or blunt vascular extremity trauma, these techniques can help to minimize blood loss, reduce operative complications, and potentially prevent limb amputation. Here, we present a narrative review of the ever-increasing role of minimally invasive interventions in the management of extremity trauma and compare its use and outcomes to open surgical repair. A special focus is placed on diagnostic imaging modalities in trauma and the role of interventional radiologists in the work-up and treatment of extremity trauma. We discuss diagnostic imaging modalities that aid in the triaging of extremity trauma, such as Doppler sonography, CT angiography, and catheterbased angiography. We present an overview on the literature related to endovascular interventions such as embolotherapy and stent grafting as well as the technical challenges associated with each technique. Finally, we present our own cases on the workup and endovascular treatment of extremity trauma, including CT angiography, particulate and coil embolization, and stent graft placement.

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Novel use of interventional radiology in trauma

Cited by 7 publications

References 0 publications

Predicting Suitable Percutaneous Endovascular Arterial Embolization for Traumatic Abdominopelvic Injuries: A Retrospective Cohort Study

Predicting Suitable Percutaneous Endovascular Arterial Embolization for Traumatic Abdominopelvic Injuries: A Retrospective Cohort Study

Subclavian artery avulsion following blunt trauma: A case report and literature review

Endovascular interventions in the management of acute extremity trauma: a narrative review

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