J Korean Soc Radiol.  2012 Nov;67(5):333-340. 10.3348/jksr.2012.67.5.333.

Efficacy of Transcatheter Arterial Embolization in the Traumatic Injury

• Park DH
• Kim JH
• Byun SS
• Kim HS

• KMID: 1819748
• DOI: http://doi.org/10.3348/jksr.2012.67.5.333

Abstract

PURPOSE
This study evaluated technical and clinical outcomes and identified factors associated with clinical success in trauma patients that underwent transcatheter arterial embolization (TAE) in a single regional hospital.
MATERIALS AND METHODS
A retrospective study was performed of 106 patients with a variety of trauma who were suspected of active arterial bleeding and underwent angiography. Technical success was defined as non-visualization of extravasation and pseudoaneurysm in injured arteries. Clinical success was defined as the patient was not expired within 30 days from the date of TAE. Electronic medical records were reviewed. The risk factors between groups of clinical success and failure were analyzed statistically.
RESULTS
Technical and clinical success rates of TAE were 96% (102/106) and 70% (74/106) respectively. Of the factors we assessed, age, older than 60 years, systolic blood pressure and heart rate at admission and after TAE, and combined brain injury were statistically significant (p < 0.05). Old age, low systolic blood pressure after TAE, and combined brain injury were significant predictors of poor prognosis in multivariate analysis.
CONCLUSION
TAE is an effective treatment for active arterial bleeding of the traumatic injury patient.

MeSH Terms

Aneurysm, False
Angiography
Arteries
Blood Pressure
Brain Injuries
Electronic Health Records
Heart Rate
Hemorrhage
Humans
Prognosis
Retrospective Studies
Risk Factors

Figure

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  Fig. 1 Treatment algorithm for the patients with traumatic injury.

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  Fig. 2 A 47-year-old man who had road traffic accident injury. A. Contrast-enhanced CT scan shows contrast extravasation (arrow) from origin of right inferior phrenic artery. There is large amount of hematoma formation in retroperitoneal space. B. Selective angiogram shows contrast extravasation (arrow) into right retroperitoneal space from right inferior phrenic artery. C. One week after embolization with microcolis (arrow), there is no contrast extravasation on follow up CT scan. The amount of hematoma is significantly decreased.

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  Fig. 3 A 47-year-old man who had pelvic bone fracture due to crushing injury. A. Selective left internal iliac arteriogram shows abrupt obstruction of anterior division (arrowhead). It suggests transection of the artery. However, we ignored the finding at that time. B. Delayed angiographic image of the same artery shows stasis (arrow) of contrast media. It reveals traumatic arterial injury.

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  Fig. 4 A 74-year-old man with car accident injury. A. Contrast-enhanced CT scan shows contrast extravasation (arrow) with large amount of surrounding hematoma formation in left lower neck and supraclavicular area. B. Selective angiography shows contrast extravasation (arrow) from small branch of left thyrocervical trunk supplying anterior spinal artery (arrowheads). We could not do embolization because of the risk of spinal cord infarction.

Reference

1. Debakey ME, Simeone FA. Battle Injuries of the Arteries in World War II: An Analysis of 2,471 Cases. Ann Surg. 1946; 123:534–579.

2. Rich NM, Baugh JH, Hughes CW. Acute arterial injuries in Vietnam: 1,000 cases. J Trauma. 1970; 10:359–369.

3. Bauer JR, Ray CE. Transcatheter arterial embolization in the trauma patient: a review. Semin Intervent Radiol. 2004; 21:11–22.

4. Bessoud B, Denys A, Calmes JM, Madoff D, Qanadli S, Schnyder P, et al. Nonoperative management of traumatic splenic injuries: is there a role for proximal splenic artery embolization? AJR Am J Roentgenol. 2006; 186:779–785.

5. Geeraerts T, Chhor V, Cheisson G, Martin L, Bessoud B, Ozanne A, et al. Clinical review: initial management of blunt pelvic trauma patients with haemodynamic instability. Crit Care. 2007; 11:204.

6. Sofocleous CT, Hinrichs C, Hubbi B, Brountzos E, Kaul S, Kannarkat G, et al. Angiographic findings and embolotherapy in renal arterial trauma. Cardiovasc Intervent Radiol. 2005; 28:39–47.

7. Sofocleous CT, Hinrichs CR, Hubbi B, Doddakashi S, Bahramipour P, Schubert J. Embolization of isolated lumbar artery injuries in trauma patients. Cardiovasc Intervent Radiol. 2005; 28:730–735.

8. Gould JE, Vedantham S. The role of interventional radiology in trauma. Semin Intervent Radiol. 2006; 23:270–278.

9. Bize PE, Duran R, Madoff DC, Golliet-Mercier N, Heim C, Pilleul F, et al. Embolization for multicompartmental bleeding in patients in hemodynamically unstable condition: prognostic factors and outcome. J Vasc Interv Radiol. 2012; 23:751.e4–760.e4.

10. Hagiwara A, Murata A, Matsuda T, Matsuda H, Shimazaki S. The usefulness of transcatheter arterial embolization for patients with blunt polytrauma showing transient response to fluid resuscitation. J Trauma. 2004; 57:271–276. discussion 276-277.

11. Jeffrey RB Jr, Cardoza JD, Olcott EW. Detection of active intraabdominal arterial hemorrhage: value of dynamic contrast-enhanced CT. AJR Am J Roentgenol. 1991; 156:725–729.

12. Krug EG, Sharma GK, Lozano R. The global burden of injuries. Am J Public Health. 2000; 90:523–526.

13. Murray CJ, Lopez AD. Mortality by cause for eight regions of the world: Global Burden of Disease Study. Lancet. 1997; 349:1269–1276.

14. Holcomb JB. Methods for improved hemorrhage control. Crit Care. 2004; 8:Suppl 2. S57–S60.

15. Kauvar DS, Wade CE. The epidemiology and modern management of traumatic hemorrhage: US and international perspectives. Crit Care. 2005; 9:Suppl 5. S1–S9.

16. Sauaia A, Moore FA, Moore EE, Moser KS, Brennan R, Read RA, et al. Epidemiology of trauma deaths: a reassessment. J Trauma. 1995; 38:185–193.

17. Agolini SF, Shah K, Jaffe J, Newcomb J, Rhodes M, Reed JF 3rd. Arterial embolization is a rapid and effective technique for controlling pelvic fracture hemorrhage. J Trauma. 1997; 43:395–399.

18. Perez JV, Hughes TM, Bowers K. Angiographic embolisation in pelvic fracture. Injury. 1998; 29:187–191.

19. Ben-Menachem Y, Coldwell DM, Young JW, Burgess AR. Hemorrhage associated with pelvic fractures: causes, diagnosis, and emergent management. AJR Am J Roentgenol. 1991; 157:1005–1014.

20. Velmahos GC, Toutouzas KG, Vassiliu P, Sarkisyan G, Chan LS, Hanks SH, et al. A prospective study on the safety and efficacy of angiographic embolization for pelvic and visceral injuries. J Trauma. 2002; 53:303–308. discussion 308.

21. Mucha P Jr, Welch TJ. Hemorrhage in major pelvic fractures. Surg Clin North Am. 1988; 68:757–773.

22. Agnew SG. Hemodynamically unstable pelvic fractures. Orthop Clin North Am. 1994; 25:715–721.

23. Poole GV, Ward EF, Muakkassa FF, Hsu HS, Griswold JA, Rhodes RS. Pelvic fracture from major blunt trauma. Outcome is determined by associated injuries. Ann Surg. 1991; 213:532–538. discussion 538-539.