Utilization of Angiography and Embolization for Abdominopelvic Trauma: 14 Years’ Experience at a Level I Trauma Center

Abstract

Purpose To evaluate the long-term trends in the use of angiography and embolization for abdominopelvic injuries. Methods Utilization rates for pelvic and abdominal angiography, arterial embolization, and computed tomography (CT) were analyzed for trauma patients with pelvic fractures, liver and kidney injuries admitted to a level I trauma center from 1996-2010. Multivariable linear regression was used to evaluate trends in the use of angioembolization. Results A total of 9,145 patients were admitted for abdominopelvic injuries. Pelvic angiography decreased annually by 5.0% (95%CI: −6.4,−3.7%) from 1996-2002 and by 1.8% (95%CI: −2.4,−1.2%) from 2003-2010. Embolization rates for these patients varied from 49% in 1997 to 100% in 2010. Utilization of pelvic CT on the day of admission increased significantly during this period. Abdominal angiography for liver and kidney injuries decreased annually by 3.3% (95%CI: −4.8,−1.8%) and 2.0% (95%CI: −4.3,0.3%) between 1996-2002 and by 0.8% (95%CI: −1.4,−0.1%) and 0.9% (95%CI: −2.0,0.1) from 2003-2010, respectively. Embolization rates ranged from 25% in 1999 to 100% in 2010 for liver injuries and from 0% in 1997 to 80% in 2002 for kidney injuries. Abdominal CT for liver and kidney injuries on the day of admission also increased. Conclusions A significant decrease in angiography use for trauma patients with pelvic fractures, liver and kidney injuries from 1996-2010 and a trend toward increasing embolization rates among patients who underwent angiography was found. These findings reflect a declining role of angiography for diagnostic purposes, while emphasizing the importance of angiography as a means to embolization for management.

Iatrogenic hemobilia: imaging features and management with transcatheter arterial embolization in 30 patients

“…However, a pseudoaneurysm of the extrahepatic arteries is usually larger and easier to identify on CT images. Roudsari et al (18) pointed to a declining role of angiography in the diagnosis of hemobilia and emphasized the importance of angiography more as a tool for management via embolization. Dilation and enhancement of the bile duct indicated inflammation of the bile duct due to repeated stimulation of the hemorrhage.…”

Liver trauma: WSES 2020 guidelines

“…Active contrast extravasation is a sign of active hemorrhage [23]. CT scan may help in subsequent Table 3 AAST liver trauma classification [24][25][26][27][28][29][30][31][32]. Diagnostic peritoneal lavage (DPL) should be considered diagnostic modality in low-resource settings, where CT scan or US is not promptly available [33].…”

Trends and Outcomes in the Operative Management of Traumatic Vascular Injuries: A Comparison of Open versus Endovascular Approaches

“…[10][11][12] Although these comparisons are important, it is also important to acknowledge the role that endovascular interventions play in treating injuries for which there is no open equivalent, such as in the embolization of pelvic hemorrhage, 13,14 or embolization of hepatic or splenic arterial branches for control of intra-abdominal injuries to either prevent the need for laparotomy or used postlaparotomy to control persistent bleeding. 13,15,16 It is not appropriate to consider, in these circumstances, the use of splenectomy or open pelvic packing as "open repairs," although they do provide alternative management strategies to the endovascular treatments available for injuries in these sites. Also, in the case of resuscitative endovascular balloon occlusion of the aorta, the use of a simple endovascular occluding aortic balloon can provide expeditious proximal aortic control with far less morbidity than aortic cross clamping in properly selected individuals.…”