Vascular and Interventional Radiology in Blunt Abdominopelvic TraumaÃ¢ÂÂ Institutional Practice and Review of the Literature

McCabe, Sam; Marini, Shekher Maddineni Corrado; Rozenblit, Grigory

doi:10.4172/2167-1222.1000324

Cited by 3 publications

(5 citation statements)

References 39 publications

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“…5 Diagnostic and interventional radiology (IR) play a major role in the diagnosis, management, and follow-up of patients injured in MVCs. 6 Since their revolutionary introduction in the 1970s, percutaneous endovascular techniques have contributed to important developments in medical equipment, damage-control strategies, and procedures, 7 and IR has become an integral part of the medical care provided by the trauma team. 8 The Society of Interventional Radiology (SIR) recommends that Percutaneous Endovascular Arterial Embolization (PEAE) in trauma patients requires the availability of an IR-ready team in the hospital within 60 minutes of the decision to proceed with angiography or transfer of the patient to another center where timely PEAE can be performed.…”

Section: Introductionmentioning

confidence: 99%

Predicting Suitable Percutaneous Endovascular Arterial Embolization for Traumatic Abdominopelvic Injuries: A Retrospective Cohort Study

Al-Sharydah¹

2022

OAEM

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Purpose This study evaluated the pre-procedural attributes of trauma patients to determine their suitability to undergo Percutaneous Endovascular Arterial Embolization (PEAE), and the current state of endovascular repair as an option for trauma-related injuries in traumatic abdominopelvic arterial injuries was explored. Patients and Methods We retrospectively evaluated the charts of 638 adults with traumatic abdominopelvic injuries treated from March 2011 to February 2021, extensively reviewing their pre-operative indices, pre-operative optimization requirements, and multi-modality imaging records. Results In total, 235 patients (30.63%) were “hemodynamically unstable” on admission, mainly due to hypotension (n=437 [68.5%]). Additionally, laboratory-defined acquired coagulopathies and inherited bleeding disorders were found in 268 patients (42.01%). The computerized tomography bleeding protocol was performed on 408 (63.94%) patients. Percutaneous endovascular therapy by arterial embolization was performed on 146 patients. The mean number of requested pre-intervention blood units for trauma patients significantly exceeded the number of units transfused post-intervention ( P <0.0005). Apart from hemodynamics (ie heart rate, mean blood pressure); hemoglobin, and lactic acid levels were independently associated indices of PEAE outcomes (p <0.01). Conclusion Despite the recommendations from the Society of Interventional Radiology on endovascular intervention for trauma and bleeding risk, 36.84% of study patients had hemodynamic instability and other unfeasible parameters that would limit the option of minimally invasive procedures. Early recognition and consideration of suitable treatment options is essential for optimizing patient outcomes. It is imperative that standardized algorithms and management protocols based on available resources be developed.

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Section: Introductionmentioning

confidence: 99%

Predicting Suitable Percutaneous Endovascular Arterial Embolization for Traumatic Abdominopelvic Injuries: A Retrospective Cohort Study

Al-Sharydah¹

2022

OAEM

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“…Pelvic bleeding from traumatic injury is a major cause of morbidity and mortality in trauma patients 1 . CT angiography in the assessment for such injuries can be performed using arterial, portal venous and delayed phases to not only identify the presence of bleeding but also to attempt to characterise its nature (arterial vs venous) and to assess for the presence of associated findings such as intimal transection, pseudoaneurysm and arteriovenous fistulae 2 .…”

Section: Introductionmentioning

confidence: 99%

Accuracy of dual‐bolus CT in the diagnosis of active arterial bleeding in adult pelvic trauma

et al. 2020

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Introduction A single‐phase dual‐bolus CT (DB‐CT) simultaneously opacifies both arterial and venous systems and can be utilised in the trauma setting to aid in the diagnosis of active bleeding while also allowing for optimal assessment of the abdominal and pelvic viscera. Active bleeding can be venous or arterial, the latter being amenable to angiography and potentially embolisation. We aimed to establish the accuracy of single‐phase DB‐CT vs commonly performed portal venous CT (PV‐CT) in the diagnosis of active bleeding when compared to formal digital subtraction angiography as the gold standard. Methods All patients diagnosed with active bleeding on PV‐CT or DB‐CT at a level 1 tertiary centre over a 6‐year period and who subsequently proceeded to digital subtraction angiography (DSA) were included for analysis. The initial CT images were retrospectively reviewed by two consultant interventional radiologists who were blinded to the subsequent outcome of the DSA and to each other’s results. The sensitivity, specificity and inter‐observer agreement between the two readers was then able to be assessed. Results A total of 60 patients were included in the analysis. Sensitivity for the diagnosis for any active bleeding was high for both DB‐CT and PV‐CT (range 88.9%–100%) while diagnosis of specifically arterial bleeding was comparatively lower (51.9%–79%). Inter‐observer agreement for the identification of arterial bleeding was better for DB‐CT (fair) compared to PV‐CT (poor). Conclusion Both PV‐CT and DB‐CT demonstrate high sensitivity in the diagnosis of any active bleeding though identification of specifically arterial bleeding is lower for both scanning methods. Nevertheless, inter‐observer reliability for the identification of arterial bleeding is higher for DB‐CT. Multi‐phase arterial and venous CT may yield better results and could be a focus for future studies.

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“…Since splenic embolization was first performed, a larger spectrum of high-grade blunt splenic trauma has been proven to be applicable for transcatheter embolization. In a large retrospective study, Bhullar et al showed a strong correlation between contrast blush on angiography with active bleeding, and the necessity to perform splenic embolization in patients receiving NOM [4]. Furthermore, in the same study, it was demonstrated that patients with grade four or five blunt splenic trauma often failed NOM in the absence of contrast blush on angiography, because transcatheter embolization was not performed [4].…”

Section: Introductionmentioning

confidence: 99%

“…In a large retrospective study, Bhullar et al showed a strong correlation between contrast blush on angiography with active bleeding, and the necessity to perform splenic embolization in patients receiving NOM [4]. Furthermore, in the same study, it was demonstrated that patients with grade four or five blunt splenic trauma often failed NOM in the absence of contrast blush on angiography, because transcatheter embolization was not performed [4]. Therefore, the resulting data showed that high-grade splenic trauma should undergo splenic embolization regardless of contrast blush on angiography to maximize the success of NOM [4].…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, in the same study, it was demonstrated that patients with grade four or five blunt splenic trauma often failed NOM in the absence of contrast blush on angiography, because transcatheter embolization was not performed [4]. Therefore, the resulting data showed that high-grade splenic trauma should undergo splenic embolization regardless of contrast blush on angiography to maximize the success of NOM [4].…”

Section: Introductionmentioning

confidence: 99%

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Pediatric Traumas and Paradigm Shifts: The Necessary Adaption of the Steerable Microcatheter in Pediatric Interventional Radiology

Harmon

Kee-Sampson

Hester

et al. 2019

Cureus

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The use of traditionally available intra-arterial devices have historically been designed with the adult patient population in mind. Currently, there are not manufactured devices specifically tailored for use during pediatric interventional procedures, pressuring interventional operators to adapt commonplace and readily available devices for interventional management. Experienced interventional operators understand that pediatric and adult interventions can entail vastly different management, affecting patient care and outcomes. To address the pitfalls in pediatric interventional management, an accredited fellowship specifically for pediatric interventional radiology is available. However, devices must equally evolve with the training available in order to adequately address interventional management of the pediatric patient population. Interventional device innovation can be considered the initial step towards bridging the technical and procedural gaps necessary for refining pediatric intervention. The introduction of steerable microcatheters in interventional radiology has innovated procedural protocols, but has never been documented in pediatric patients until this time.

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Vascular and Interventional Radiology in Blunt Abdominopelvic TraumaÃ¢ÂÂ Institutional Practice and Review of the Literature

Cited by 3 publications

References 39 publications

Predicting Suitable Percutaneous Endovascular Arterial Embolization for Traumatic Abdominopelvic Injuries: A Retrospective Cohort Study

Predicting Suitable Percutaneous Endovascular Arterial Embolization for Traumatic Abdominopelvic Injuries: A Retrospective Cohort Study

Accuracy of dual‐bolus CT in the diagnosis of active arterial bleeding in adult pelvic trauma

Pediatric Traumas and Paradigm Shifts: The Necessary Adaption of the Steerable Microcatheter in Pediatric Interventional Radiology

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Vascular and Interventional Radiology in Blunt Abdominopelvic TraumaÃ¢ÂÂ Institutional Practice and Review of the Literature

Cited by 3 publications

References 39 publications

Predicting Suitable Percutaneous Endovascular Arterial Embolization for Traumatic Abdominopelvic Injuries: A Retrospective Cohort Study

Predicting Suitable Percutaneous Endovascular Arterial Embolization for Traumatic Abdominopelvic Injuries: A Retrospective Cohort Study

Accuracy of dual‐bolus CT in the diagnosis of active arterial bleeding in adult pelvic trauma

Pediatric Traumas and Paradigm Shifts: The Necessary Adaption of the Steerable Microcatheter in Pediatric Interventional Radiology

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Vascular and Interventional Radiology in Blunt Abdominopelvic TraumaÃ¢ÂÂ Institutional Practice and Review of the Literature