Role of Angio-Embolisation in Trauma-Review

Durai, Rajaraman; Ng, P. C.

doi:10.1080/00015458.2010.11680592

Cited by 4 publications

(3 citation statements)

References 59 publications

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“…Very few studies were identified evaluating the clinical effectiveness of RBC or blood component therapy. Only two studies were identified which evaluated surgical or mechanical interventions, which is surprising given the interest in damage control surgery [72] and angio-embolization [73]. Tranexamic acid was the only pharmaceutical agent that improved mortality [56].…”

Section: Discussionmentioning

confidence: 99%

The acute management of trauma hemorrhage: a systematic review of randomized controlled trials

et al. 2011

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IntroductionWorldwide, trauma is a leading cause of death and disability. Haemorrhage is responsible for up to 40% of trauma deaths. Recent strategies to improve mortality rates have focused on optimal methods of early hemorrhage control and correction of coagulopathy. We undertook a systematic review of randomized controlled trials (RCT) which evaluated trauma patients with hemorrhagic shock within the first 24 hours of injury and appraised how the interventions affected three outcomes: bleeding and/or transfusion requirements; correction of trauma induced coagulopathy and mortality.MethodsComprehensive searches were performed of MEDLINE, EMBASE, CENTRAL (The Cochrane Library Issue 7, 2010), Current Controlled Trials, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform (ICTRP) and the National Health Service Blood and Transplant Systematic Review Initiative (NHSBT SRI) RCT Handsearch Database.ResultsA total of 35 RCTs were identified which evaluated a wide range of clinical interventions in trauma hemorrhage. Many of the included studies were of low methodological quality and participant numbers were small. Bleeding outcomes were reported in 32 studies; 7 reported significantly reduced transfusion use following a variety of clinical interventions, but this was not accompanied by improved survival. Minimal information was found on traumatic coagulopathy across the identified RCTs. Overall survival was improved in only three RCTs: two small studies and a large study evaluating the use of tranexamic acid.ConclusionsDespite 35 RCTs there has been little improvement in outcomes over the last few decades. No clear correlation has been demonstrated between transfusion requirements and mortality. The global trauma community should consider a coordinated and strategic approach to conduct well designed studies with pragmatic endpoints.

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Section: Discussionmentioning

confidence: 99%

The acute management of trauma hemorrhage: a systematic review of randomized controlled trials

et al. 2011

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“…The majority of patients diagnosed with a pseudoaneurysm required more invasive intervention. Endovascular treatment currently remains first‐line therapy, particularly for abdominal/pelvic pseudoaneurysms 13,19 . However, Cordova et al 6 argued that endovascular techniques should be (in most cases) reserved electively and for poor surgical candidates due to the higher morbidity and mortality associated with endovascular technique in the emergent setting.…”

Section: Discussionmentioning

confidence: 99%

A 10‐year retrospective review of management and outcomes of pseudoaneurysms at a tertiary referral centre

et al. 2021

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Introduction Pseudoaneurysms are uncommon but potentially life‐threatening. Treatment may involve a variety of interventions including observation, manual compression, ultrasound‐guided thrombin injection and a variety of endovascular and surgical techniques. Current treatments are largely based on observational data and there is no consensus on management. This study aimed to provide evidence for guiding clinical decisions regarding visceral artery pseudoaneurysm and peripheral artery pseudoaneurysm management. Methods Retrospective single‐centre review of patients diagnosed with visceral and peripheral artery pseudoaneurysms at a tertiary hospital (2010–2020). Results There were 285 patients included in this study. A total of 86 patients were diagnosed with a visceral artery pseudoaneurysm, and 49 of these (57%) were caused by trauma. A total of 199 patients were identified with a peripheral pseudoaneurysm; 76 of these (38%) were caused by trauma and 69 (35%) were due to access site complication during an endovascular procedure. Initial technical success was achieved in 266 patients (93.3%) with 19 requiring an additional treatment to achieve success. Conservative treatment (100% success), endovascular treatment (98.1%) and surgery (100%) were more successful than ultrasound‐guided compression (63.6%) and thrombin injection (83.8%). The median time from diagnosis to intervention was <9 h for visceral artery pseudoaneurysms and 24 h for peripheral artery pseudoaneurysms. There was no change in survival outcomes with respect to time from diagnosis and intervention. Conclusion In this study, pseudoaneurysms were treated with a high degree of success by observation or by using an endovascular approach, and those requiring endovascular intervention did not need to be treated immediately in an emergent setting.

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“…Advanced or novel therapeutic methods applied either simultaneously or in a priority oriented way with the multidisciplinary cooperation of different specialists, have also contributed in the improved quality of the provided polytrauma care. In addition to standard life saving surgery such as laparotomy, thoracotomy or application of a pelvic C-clamp and concomitant pelvic packing (Probst et al, 2009), advances made in interventional radiology have improved the management of patients with solid organ trauma or pelvic ring injuries by angio-embolisation without the need for immediate surgical intervention or as adjunct to damage-control surgery in complex injury patterns (Shaftan, 2008; Durai and Ng, 2010). However, such interventions are not without risks and, although less invasive, patients should be followed up carefully (Durai and Ng, 2010).…”

Section: Introductionmentioning

confidence: 99%

Polytrauma – new horizons for management

Dimitriou

Calori

Giannoudis

2011

Trauma

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The management of polytrauma has evolved considerably in the last century. Advances have been made in all disciplines involved in trauma care from pre-hospital care and resuscitation protocols to diagnostics, surgical techniques, administration of novel pharmacological agents and late reconstruction procedures. Improved understanding of the altered physiology and the induced response at the molecular level offers the potential for novel management strategies and prevention of post-traumatic complications.

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Role of Angio-Embolisation in Trauma-Review

Cited by 4 publications

References 59 publications

The acute management of trauma hemorrhage: a systematic review of randomized controlled trials

The acute management of trauma hemorrhage: a systematic review of randomized controlled trials

A 10‐year retrospective review of management and outcomes of pseudoaneurysms at a tertiary referral centre

Polytrauma – new horizons for management

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