The role of interventional radiology in abdominopelvic trauma

Abstract

The management of trauma patients has evolved in recent decades owing to increasing availability of advanced imaging modalities such as CT. Nowadays, CT has replaced the diagnostic function of angiography. The latter is considered when a therapeutic option is hypothesized. Arterial embolization is a life-saving procedure in abdominopelvic haemorrhagic patients, reducing relevant mortality rates and ensuring haemodynamic stabilization of the patient. Percutaneous transarterial embolization has been shown to be effective for controlling ongoing bleeding for patients with high-grade abdominopelvic injuries, thereby reducing the failure rate of non-operative management, preserving maximal organ function. Surgery is not always the optimal solution for stabilization of a patient with polytrauma. Mini-invasivity and repeatability may be considered as relevant advantages. We review technical considerations, efficacy and complication rates of hepatic, splenic, renal and pelvic embolization to extrapolate current evidence about transarterial embolization in traumatic patients.

Contemporary Role of Embolization of Solid Organ and Pelvic Injuries in Polytrauma Patients

“…The materials that are used to embolize liver injuries are coils, gelfoam, and PVA particles, and the mean technical success is 94.9%, while the mean clinical success approximates 79.8% (19). …”

“…The reported embolic materials that are used in renal injuries are coils, gelfoam, glue, Onyx, and PVA particles (19). Mean technical success is 96.2%, mean clinical success is 90.9%, and overall rebleeding rate can reach 25.6% (19).…”

“…Mean technical success is 96.2%, mean clinical success is 90.9%, and overall rebleeding rate can reach 25.6% (19). …”

“…Technical success is defined as exclusion of the bleeding site at postembolization angiography and has a mean value of 98.9%, while clinical success, which is defined as the percentage of hemodynamically stable patients after angioembolization, has a mean value of 91.7% (19, 23). …”

Management of Critical Bleeding in Trauma Patients: Between Recommendations and Reality

“…In some cases of polytrauma, especially fractures of the pelvic ring, surgery is not always a choice. Interventional radiology for controlling of the bleeding in abdominal-pelvic trauma is a life-saving procedure and might be used [28], but lack of resources is the main reason why it is used in a very small number of selected patients.…”