Society of Interventional Radiology Position Statement on Endovascular Intervention for Trauma

Padia, Siddharth A.; Ingraham, Christopher R.; Moriarty, John M.; Wilkins, Lippincott Williams; Bream, Peter R.; Tam, Alda L.; Patel, Sheena; McIntyre, Lisa; Wolinsky, Philip R; Hanks, Sue E.

doi:10.1016/j.jvir.2019.11.012

Cited by 63 publications

(93 citation statements)

References 82 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Specifically, technical success was 100% and only one case of rebleeding/repeat TAE was recorded that was successfully treated with further TAE. The clinical safety and effectiveness of TAE has been widely reported in the literature, establishing its role in bleeding control (Spiliopoulos et al 2019;Hur et al 2014;Melloul et al 2015;Padia et al 2020). However, uncorrected coagulopathy related to anticoagulation, haemophilia, cirrhosis or severe trauma is a relative contraindication for TAE, as it has been previously reported as a significant negative predictor for recurrent bleeding, in-hospital mortality and procedure-related complication rates, up to 3.5 times more likely to result in clinical failure (Hur et al 2014;Valek and Husty 2013;Angle et al 2010;Loffroy et al 2010;Lopera 2010).…”

Section: Discussionmentioning

confidence: 99%

Multicenter retrospective study of transcatheter arterial embolisation for life-threatening haemorrhage in patients with uncorrected bleeding diathesis

et al. 2020

View full text Add to dashboard Cite

Background We retrospectively investigated outcomes of emergency TAE for the management of life-threatening haemorrhage in patients with uncorrected bleeding diathesis. Materials and methods This multicenter, retrospective, study, was designed to investigate the safety and efficacy of percutaneous TAE for the management of life-threatening haemorrhage in patients with uncorrected bleeding disorder at the time of embolization. All consecutive patients with uncorrected coagulation who underwent TAE for the treatment of haemorrhage, between January 1st and December 31th 2019 in three European centers were included. Inclusion criteria were thrombocytopenia (platelet count < 50,000/mL) and/or International Normalized Ratio (INR) ≥2.0, and/or activated partial thromboplastin time (aPTT) > 45 s, and/or a pre-existing underlying blood-clotting disorder such as factor VIII, Von Willebrand disease, hepatic cirrhosis with abnormal liver function tests. Primary outcome measures were technical success, rebleeding rate and clinical success. Secondary outcome measures included patients’ 30-day survival rate, and procedure-related complications. Results In total, 134 patients underwent TAE for bleeding control. A subgroup of 17 patients with 18 procedures [11 female, mean age 70.5 ± 15 years] which represent 12.7% of the total number of patients, presented with pathological coagulation parameters at the time of TAE (haemophilia n = 3, thrombocytopenia n = 1, cirrhosis n = 5, anticoagulants n = 7, secondary to bleeding n = 1) and were analyzed. Technical success was 100%, as in all procedures the bleeding site was detected and successfully embolised. Clinical success was 100%, as none of the patients died of bleeding during hospitalization, nor was surgically treated for bleeding relapse. Only one rebleeding case was noted (5.9%) that was successfully treated with a second TAE. No procedure-related complications were noted. According to Kaplan-Meier analysis the estimated 30-day survival rate was 84.2%. Conclusion TAE in selected patients with uncorrected bleeding diathesis should be considered as a suitable individualized management approach. Emergency TAE for life threatening haemorrhage in patients with coagulation cascade disorders should be used as an aid in realistic clinical decision making.

show abstract

Section: Discussionmentioning

confidence: 99%

Multicenter retrospective study of transcatheter arterial embolisation for life-threatening haemorrhage in patients with uncorrected bleeding diathesis

et al. 2020

View full text Add to dashboard Cite

show abstract

“…7,8 The Society or Interventional Radiology and the American College of Surgery Committee had recently recommended that the IR team should be ready to intervene within 60 minutes from the time a joint decision is made to proceed with angiography. 9 The expedited and safe control of hemorrhage with embolization requires a comprehensive understanding of the basic and advanced embolization techniques and materials. 10…”

mentioning

confidence: 99%

Embolization in Trauma: Review of Basic Principles and Techniques

Lopera

2021

Semin intervent Radiol

View full text Add to dashboard Cite

Trauma is the leading cause of death in patients younger than 45 years. Over the last decade, there has been a progressive paradigm shift toward a nonoperative management of many blunt and penetrating injuries, placing interventional radiology in the forefront in this critical field. Transcatheter embolization is an established technique that plays a significant role in the modern treatment of traumatic injuries of the extremities, pelvis, and solid organs. The purpose of this article is to review the updated principles and techniques used in transcatheter embolization in trauma.

show abstract

“…Active bleeding can be detected either on CT angiography (detection of a "blush") or with decreasing serial hematocrit measurements. 3 Grade III and IV injuries are more likely to undergo initial angiographic evaluation, with almost 83% success rate. 2 Arterial embolization protocol uses microcatheter systems and subselective embolization techniques.…”

Section: Angiographic Managementmentioning

confidence: 99%

“…The right lobe is commonly injured from side impact trauma and is more frequently associated with concurrent injuries to other organ structures. 3…”

mentioning

confidence: 99%

Hepatic Trauma Interventions

Pillai

Kumar

Pillai

2021

Semin intervent Radiol

View full text Add to dashboard Cite

The liver is the second most commonly involved solid organ (after spleen) to be injured in blunt abdominal trauma, but liver injury is the most common cause of death in such trauma. In patients with significant blunt abdominal injury, the liver is involved approximately 35 to 45% of the time. Its large size also makes it a vulnerable organ, commonly injured in penetrating trauma. Other than its position and size, the liver is surrounded by fragile parenchyma and its location under the diaphragm makes it vulnerable to shear forces during deceleration injuries. The liver is also a vascular organ made of large, thin-walled vessels with high blood flow. In severe hepatic trauma, hemorrhage is a common complication and uncontrolled bleeding is usually fatal. In fact, in patients with severe abdominal trauma, liver injury is the primary cause of death. This article reviews the clinical presentation of patients with liver injury, the grading system for such injuries that is most frequently used, and management of the patient with liver trauma.

show abstract

Society of Interventional Radiology Position Statement on Endovascular Intervention for Trauma

Cited by 63 publications

References 82 publications

Multicenter retrospective study of transcatheter arterial embolisation for life-threatening haemorrhage in patients with uncorrected bleeding diathesis

Multicenter retrospective study of transcatheter arterial embolisation for life-threatening haemorrhage in patients with uncorrected bleeding diathesis

Embolization in Trauma: Review of Basic Principles and Techniques

Hepatic Trauma Interventions

Contact Info

Product

Resources

About