Repeated embolization of intercostal arteries after blunt chest injury

Nemoto, Chiaki; Ikegami, Yukihiro; Suzuki, Tsuyoshi; Tsukada, Yasuhiko; Abe, Yoshinobu; Shimada, Jiro; Tase, Choichiro

doi:10.1007/s11748-013-0269-6

Cited by 9 publications

(7 citation statements)

References 8 publications

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“…Angiography and embolisation are currently accepted as highly effective means with which to control arterial bleeding that cannot be controlled by fracture stabilisation [ 146 , 332 , 336 , 339 , 341 , 343 , 344 ]. Radiological management can also be usefully applied to abdominal and thoracic bleeding [ 345 – 349 ]. Martinelli et al [ 350 ] report the use of intra-aortic balloon occlusion to reduce bleeding and permit transport to the angiography theatre.…”

Section: Resultsmentioning

confidence: 99%

The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition

et al. 2016

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BackgroundSevere trauma continues to represent a global public health issue and mortality and morbidity in trauma patients remains substantial. A number of initiatives have aimed to provide guidance on the management of trauma patients. This document focuses on the management of major bleeding and coagulopathy following trauma and encourages adaptation of the guiding principles to each local situation and implementation within each institution.MethodsThe pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma was founded in 2004 and included representatives of six relevant European professional societies. The group used a structured, evidence-based consensus approach to address scientific queries that served as the basis for each recommendation and supporting rationale. Expert opinion and current clinical practice were also considered, particularly in areas in which randomised clinical trials have not or cannot be performed. Existing recommendations were reconsidered and revised based on new scientific evidence and observed shifts in clinical practice; new recommendations were formulated to reflect current clinical concerns and areas in which new research data have been generated. This guideline represents the fourth edition of a document first published in 2007 and updated in 2010 and 2013.ResultsThe guideline now recommends that patients be transferred directly to an appropriate trauma treatment centre and encourages use of a restricted volume replacement strategy during initial resuscitation. Best-practice use of blood products during further resuscitation continues to evolve and should be guided by a goal-directed strategy. The identification and management of patients pre-treated with anticoagulant agents continues to pose a real challenge, despite accumulating experience and awareness. The present guideline should be viewed as an educational aid to improve and standardise the care of the bleeding trauma patients across Europe and beyond. This document may also serve as a basis for local implementation. Furthermore, local quality and safety management systems need to be established to specifically assess key measures of bleeding control and outcome.ConclusionsA multidisciplinary approach and adherence to evidence-based guidance are key to improving patient outcomes. The implementation of locally adapted treatment algorithms should strive to achieve measureable improvements in patient outcome.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1265-x) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition

et al. 2016

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“…Endovascular embolisation of the segmental artery has been described and advocated by several authors and has been used effectively to control the haemodynamic status of patients [2] , [7] , [8] , [9] , [10] . For this patient, embolisation of the bleeding vessel served in improving the radiculopathy secondary to the psoas haematoma compressing the lumbar plexus.…”

Section: Discussionmentioning

confidence: 99%

A case report of an unusual cause of postoperative leg pain after posterior lumbar fusion

Daureeawoo

Baliga

Mohahmed

et al. 2017

Annals of Medicine &Amp; Surgery

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We report the case of a 36-year old man who underwent elective posterior lumbar spinal fusion after presenting with bilateral leg pain with associated back pain. He had undergone a L5/S1 discectomy in 2001, which provided good symptomatic relief. On this admission, he underwent elective L4-S1 posterolateral fusion and bilateral L4/5 and L5/S1 decompression. Intra-operatively a pedicle screw had to be re-inserted after fluoroscopy confirmed a lateral breech. The patient had no major postoperative complications until the sixth day when the patient re-presented with acute leg pain and weakness. Following a local multidisciplinary meeting (MDT) an MRI showed a large haematoma at the right psoas muscle. CT angiogram confirmed a bleeding lumbar segmental vessel at the site of the previous misplaced screw and an emergency fluoroscopic guided embolisation of the vessel was performed. The patient recovered well post operatively and was discharged back to the community 12 days later. Haemorrhage, as in this case a psoas haematoma should be considered as one of the differentials in patients with recurrent post-operative radiculopathy following posterior lumbar spine fusion. This should be suspected particularly if there has been a misplacement of one or more screws as this can cause injury to blood vessels and be fatal for the patient.

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“…Sometimes it is more than just an intercostal artery that needs to be embolized to prevent ongoing bleeding from collateral pathways. 58 TAE of intercostal arteries is a minimally invasive, safe, and valid alternative to thoracotomy in patients with an active thoracic cage hemorrhage. However, TAE is not without risks.…”

Section: Arteriographymentioning

confidence: 99%

Imaging Assessment of Thoracic Cage Injuries

Iacobellis

Iadevito

Ierardi

et al. 2017

Semin Musculoskelet Radiol

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Thoracic injuries are the third most common traumatic injury. Approximately two thirds of thoracic injuries are due to motor vehicle collisions. They are associated with up to a 20% mortality rate. This is primarily due to the presence of several complex anatomical structures within the thoracic cage such as the heart, great vessels, esophagus, airways, lungs, mediastinum, bones, muscles, diaphragm, and pleura. A chest radiograph is the initial imaging modality in the evaluation of the chest. However, multidetector computer tomography (MDCT) with intravenous contrast is the imaging modality of choice in the assessment of acute thoracic injuries.Endovascular repair is less invasive and has a better outcome than traditional surgical repair. This review article discusses the indications, benefits, and findings of radiographs and MDCT in patients with thoracic injuries, especially with regard to the thoracic aorta.

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Repeated embolization of intercostal arteries after blunt chest injury

Cited by 9 publications

References 8 publications

The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition

The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition

A case report of an unusual cause of postoperative leg pain after posterior lumbar fusion

Imaging Assessment of Thoracic Cage Injuries

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