Angioembolization is necessary with any volume of contrast extravasation in blunt trauma

Abstract

Introduction:Reduction of nonessential angiogram and embolization for patients sustaining blunt abdominal and pelvic trauma would allow improved utilization and decreased morbidity related to nontherapeutic embolization. We hypothesized that the nature of intravenous contrast extravasation (IVCE) on computed tomography (CT) would be directly related to the finding of extravasation on angiogram and need for embolization.Methods:A 5-year retrospective evaluation of trauma patients with IVCE on CT. Demographics, hemodynamics, and IVCE location and maximal dimension/volume were examined for relationship to IVCE on angiography and need for embolization. Primary complications were defined as nephropathy and acute respiratory distress syndrome.Results:A total of 128 patients were identified with IVCE on CT. Ninety-seven (75.8%) also had IVCE identified on angiography requiring some form of embolization. The size of IVCE on CT was not related to IVCE on angiogram (P = 0.69). Location of IVCE was related to need for embolization, with spleen embolization (85.4%) being much more frequent than liver (51.5%, P = 0.006). Complication rate was 8.7% in all patients, and was not different between patients undergoing embolization and those who did not (P = 0.40).Conclusion:IVCE volume was not predictive of continued bleeding and need for embolization. However, splenic injuries with IVCE required embolization more frequently. In contrast, liver injuries were found to have infrequent on-going IVCE on angiography. Complications associated with angiogram with or without embolization are infrequent, and CT findings may not be predictive of ongoing bleeding. We do not recommend selective exclusion of patients from angiographic evaluation when a blush is present.

Institutional Review of Hemorrhagic Pelvic Emergencies Effectively Managed with Percutaneous Arterial Embolization

“…The technique was described in 1972 by Margolies and colleagues and is reported to be effective in patients bleeding from small arterial branches of the internal iliac artery. Increasingly, AE is used as a nonoperative method to address injury after blunt trauma in hemodynamically stable patients [ 4 ], whereas pelvic packing is an effective intervention in hemodynamically unstable patients. AE is also helpful in post-surgical cases where major surgeries, such as tumor resection etc., have been successfully performed; however, small vascular bleeds may result as a complication.…”

Utility of Angioembolization in Patients with Abdominal and Pelvic Traumatic Bleeding: Descriptive Observational Analysis from a Level 1 Trauma Center

“…[13][14][15][16][17][18][19][20][21][22][23][24][25] However, Diamond et al; reported that nearly half of patients may not need any interventions especially in the retroperitoneum and the pelvis areas regardless of the size or volume of the bleed. 26,27 Selection of embolic agents in trauma patients is guided by the size of the vessels to be occluded and permanence of the desired occlusion. Coils are also commonly used for trauma patients, most often when permanent occlusion is desired.…”

Utility Of Angioembolization In Patients with Abdominal and Pelvic Traumatic Bleeding: Descriptive Observational Analysis From A Level 1 Trauma Center

“…However, it remains a high-risk factor for failure of NOM for SOI (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). However, Diamond et al; reported that nearly half of patients may not need any interventions especially in the retroperitoneum and the pelvis areas regardless of the size or volume of the bleed (26,27).…”