Trans-arterial embolisation (TAE) in haemorrhagic pelvic injury: review of management and mid-term outcome of a major trauma centre

Awwad, Amir; Dhillon, Permesh Singh; Ramjas, Greg; Habib, Said; Al-Obaydi, Waleed

doi:10.1186/s42155-018-0031-3

Cited by 24 publications

(17 citation statements)

References 60 publications

(93 reference statements)

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“…Since the 1970s, the use of TAE in pelvic fractures has continued to increase with reported success rates between 80% and 100% depending on the definition of "success". 12,[16][17][18] In our study, patients who underwent angiography were found to be significantly older and were more likely to be male versus those who did not have angiography. No significant difference was found between mortality, ICU LOS, or hospital LOS in these 2 cohorts.…”

Section: Discussionmentioning

confidence: 52%

Is Blush on CT Scan in Patients With Pelvic Fracture Associated With Embolization Rates and Outcomes?

Koganti

Grady

Nguyen

et al. 2020

The American Surgeon™

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Introduction In trauma patients with pelvic fractures, computed tomography (CT) scans are a critical tool to evaluate life-threatening hemorrhage. Contrast extravasation, or “blush”, on CT may be a sign of bleeding, prompting a consult for angiography and possible embolization. However, the utility of blush on CT is controversial. We sought to evaluate our experience with patients who sustained pelvic fractures and had blush on CT. Method A retrospective review was performed for all patients with blunt pelvic fractures between January 1, 2017 and December 31, 2018. Demographic, clinical, radiographic, and injury data were obtained. Comparison of mortality, hospital length of stay (LOS), and intensive care unit (ICU) LOS was performed for 3 subgroups: angio versus no angio; embo versus no embo; prophylactic embo versus therapeutic embo. We also calculated the sensitivity, specify, positive predictive value (PPV), and negative predictive value (NPV) of CT blush to predict the need for embolization. Results 889 patients were found to have a blunt pelvic fracture. 51 patients had blush on CT scan. 29 (56.9%) underwent angiography. 17 (58.6%) of these 29 patients were found to have extravasation and were embolized. 12 patients had an angio with no extravasation, and 6 of these patients (50%) underwent prophylactic embolization. No significant difference was found for hospital LOS, ICU LOS, or mortality in our 3 groups. Sensitivity, specificity, PPV, and NPV for CT blush were 74%, 96%, 33%, 99%, respectively. Conclusion Patients with active extravasation undergoing embolization had similar outcomes to patients without active extravasation. Blush on CT scan had low sensitivity and low PPV but high specificity and high NPV. Future studies need to include careful attention to the CT protocol utilized as well as patient selection.

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Section: Discussionmentioning

confidence: 52%

Is Blush on CT Scan in Patients With Pelvic Fracture Associated With Embolization Rates and Outcomes?

Koganti

Grady

Nguyen

et al. 2020

The American Surgeon™

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“…According to the Eastern Association for Surgery of Trauma guidelines, when the cause of bleeding is intra-abdominal haemorrhage or intra-abdominal organ damage, TAE is a treatment option as long as the patient's vital signs are stable [4]. Furthermore, when the cause of bleeding is retroperitoneal haemorrhage such as from pelvic fracture, TAE is the rst choice for bleeding control, even if the patient's vital signs are unstable [16]. Kuo et al reported that in trauma with haemorrhagic shock, there were cases requiring TAE among those who did not initially show extravasation on CE-CT scanning.…”

Section: Discussionmentioning

confidence: 99%

The Accuracy of Contrast-enhanced Computed Tomography Scans to Detect Postpartum Haemorrhage: An Observational Study

Mitsuyama

Katayama

et al. 2021

Preprint

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Introduction: Postpartum haemorrhage is a major cause of maternal mortality. Although contrast-enhanced computed tomography (CE-CT) is useful to reveal arterial bleeding, its accuracy in postpartum haemorrhage is unclear. The aim of this study was to evaluate the accuracy of CE-CT scanning in detecting postpartum haemorrhage.Methods: This was a retrospective observational study. We included patients with postpartum haemorrhage treated by emergency physicians in collaboration with obstetricians. We calculated the sensitivity, specificity, and positive and negative predictive values for CE-CT scanning to detect arterial bleeding.Results: CE-CT scanning was performed in 52 patients, and 31 patients had extravasation. The sensitivity of CE-CT scanning to detect arterial extravasation was 100% (15/15), specificity was 28.6% (2/7), positive predictive value was 75% (15/20), and negative predictive value was 100% (2/2).Conclusion: We showed the sensitivity of CE-CT scanning to detect arterial extravasation in patients with postpartum haemorrhage to be 100%.

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“…The other patient had angiography performed at a time interval of more than 5 h after a negative CT, due to increasing hemodynamic instability. Such discrepancy between extravasation seen on CT and angiography can be related to vessel spasm after secondary local inflammatory response in patients with bleeding or hypotension [ 37 , 43 ]. According to Dreizin et al, arterial bleeding can be occult at CT in 20–40% of patients [ 41 , 44 ].…”

Section: Discussionmentioning

confidence: 99%

Do we really need the arterial phase on CT in pelvic trauma patients?

et al. 2020

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Purpose To evaluate whether an arterial phase scan improves the diagnostic performance of computed tomography to identify pelvic trauma patients who received angiographic intervention on demand of the trauma surgeon. Methods This retrospective single-center study was performed at an academic Scandinavian trauma center with approximately 2000 trauma admissions annually. Pelvic trauma patients with arterial and portal venous phase CT from 2009 to 2015 were included. The patients were identified from the institutional trauma registry. Images were interpreted by two radiologists with more than 10 years of trauma radiology experience. Positive findings for extravasation on portal venous phase alone or on both arterial and portal venous phase were compared, with angiographic intervention as clinical outcome. Results One hundred fifty-seven patients (54 females, 103 males) with a median age of 45 years were enrolled. Sixteen patients received angiographic intervention. Positive CT findings on portal venous phase only had a sensitivity and specificity of 62% and 86%, vs. 56% and 93% for simultaneous findings on arterial and portal venous phase. Specificity was significantly higher for positive findings in both phases compared with portal venous phase only. Applying a threshold > 0.9 cm of extravasation diameter to portal venous phase only resulted in sensitivity and specificity identical to those of both phases. Conclusion Arterial phase scan in addition to portal venous phase scan did not improve patient selection for angiography. Portal venous phase extravasation size alone may be used as an imaging-based biomarker of the need for angiographic intervention.

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Trans-arterial embolisation (TAE) in haemorrhagic pelvic injury: review of management and mid-term outcome of a major trauma centre

Cited by 24 publications

References 60 publications

Is Blush on CT Scan in Patients With Pelvic Fracture Associated With Embolization Rates and Outcomes?

Is Blush on CT Scan in Patients With Pelvic Fracture Associated With Embolization Rates and Outcomes?

The Accuracy of Contrast-enhanced Computed Tomography Scans to Detect Postpartum Haemorrhage: An Observational Study

Do we really need the arterial phase on CT in pelvic trauma patients?

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