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Qamar SR, Green CR, Ghandehari H, Holmes S, Hurley S, Khumalo Z, Mohammed MF, Ziesmann M, Jain V, Thavanathan R, Berger FH. CETARS/CAR Practice Guideline on Imaging the Pregnant Trauma Patient. Can Assoc Radiol J 2024; 75:743-750. [PMID: 38813997 DOI: 10.1177/08465371241254966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024] Open
Abstract
Imaging of pregnant patients who sustained trauma often causes fear and confusion among patients, their families, and health care professionals regarding the potential for detrimental effects from radiation exposure to the fetus. Unnecessary delays or potentially harmful avoidance of the justified imaging studies may result from this understandable anxiety. This guideline was developed by the Canadian Emergency, Trauma and Acute Care Radiology Society (CETARS) and the Canadian Association of Radiologists (CAR) Working Group on Imaging the Pregnant Trauma Patient, informed by a literature review as well as multidisciplinary expert panel opinions and discussions. The working group included academic subspecialty radiologists, a trauma team leader, an emergency physician, and an obstetriciangynaecologist/maternal fetal medicine specialist, who were brought together to provide updated, evidence-based recommendations for the imaging of pregnant trauma patients, including patient safety aspects (eg, radiation and contrast concerns) and counselling, initial imaging in maternal trauma, specific considerations for the use of fluoroscopy, angiography, and magnetic resonance imaging. The guideline strives to achieve clarity and prevent added anxiety in an already stressful situation of injury to a pregnant patient, who should not be imaged differently.
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Affiliation(s)
- Sadia R Qamar
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | | | - Hournaz Ghandehari
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Signy Holmes
- Department of Radiology, University of Manitoba, Max Rady College of Medicine, Winnipeg, MB, Canada
| | - Sean Hurley
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
| | - Zonah Khumalo
- Department of Medical Imaging, McGill University Health Centre, Montreal Children's Hospital, Montreal, QC, Canada
| | - Mohammed F Mohammed
- Department of Radiology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Markus Ziesmann
- Department of Surgery, University of Manitoba, Max Rady College of Medicine, Winnipeg, MB, Canada
| | - Venu Jain
- Department of Obstetrics & Gynaecology, University of Alberta, Edmonton, AB, Canada
| | - Rajiv Thavanathan
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Ferco H Berger
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Ascenti V, Ierardi AM, Alfa-Wali M, Lanza C, Kashef E. Damage Control Interventional Radiology: The bridge between non-operative management and damage control surgery. CVIR Endovasc 2024; 7:71. [PMID: 39358662 PMCID: PMC11447184 DOI: 10.1186/s42155-024-00485-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Accepted: 09/12/2024] [Indexed: 10/04/2024] Open
Abstract
Traumatic injuries continue to be on the rise globally and with it, the role interventional radiology (IR) has also expanded in managing this patient cohort. The role of damage control surgery (DCS) has been well established in the trauma management pathway, however it is only recently that Damage Control IR (DCIR) has become increasingly utilized in managing the extremis trauma and emergency patient.Visceral artery embolizations (both temporary and permanent), temporary balloon occlusions including Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in iliac arteries and aorta respectively are amongst the treatment options now available for the trauma (and non-traumatic bleeding) patient.We review the literature for the role of DCS and utilization of IR in trauma, outcomes and the paradigm shift towards minimally invasive techniques. The focus of this paper is to highlight the importance of multi-disciplinary working and having established pathways to ensure timely treatment of trauma patients as well as careful patient selection.We show that outcomes are best when both surgical and IR are involved in patient care from the outset and that DCIR should not be defined as Non-Operative Management (NOM) as it currently is categorized as.
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Affiliation(s)
- Velio Ascenti
- Postgraduate School of Radiology, University of Milan, Milan, IT, Italy
| | - Anna Maria Ierardi
- Radiology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, IT, Italy
| | - Maryam Alfa-Wali
- Major Trauma Centre, Imperial College Healthcare NHS Trust, London, UK
| | - Carolina Lanza
- Radiology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, IT, Italy
| | - Elika Kashef
- Department of Imaging, Imperial College Healthcare NHS Trust, London, W2 1NY, UK.
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Ryce AL, Hanna T, Smith R, Duszak R, Ahmed O, Xing M, Kokabi N. Contemporary Management of Blunt Splenic Trauma in Adults: An Analysis of the Trauma Quality Improvement Program Registry. J Am Coll Radiol 2024; 21:1453-1463. [PMID: 38492766 DOI: 10.1016/j.jacr.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 02/06/2024] [Accepted: 03/01/2024] [Indexed: 03/18/2024]
Abstract
PURPOSE The aim of this study was to evaluate the effectiveness of management strategies for blunt splenic injuries in adult patients. METHODS Patients 18 years and older with blunt splenic injuries registered via the Trauma Quality Improvement Program (2013-2019) were identified. Management strategies initiated within 24 hours of hospital presentation were classified as watchful waiting, embolization, surgery, or combination therapy. Patients were stratified by injury grade. Linear models estimated each strategy's effect on hospital length of stay (LOS), intensive care unit (ICU) LOS, and mortality. RESULTS Of 81,033 included patients, 86.3%, 10.9%, 2.5%, and 0.3% of patients received watchful waiting, surgery, embolization, and combination therapy, respectively. Among patients with low-grade injuries and compared with surgery, embolization was associated with shorter hospital LOS (9.4 days, Q < .001, Cohen's d = .30) and ICU LOS (5.0 days, Q < .001, Cohen's d = .44). Among patients with high-grade injuries and compared with surgery, embolization was associated with shorter hospital LOS (8.7 days, Q < .001, Cohen's d = .12) and ICU LOS (4.5 days, Q < .001, Cohen's d = .23). Among patients with low- and high-grade injuries, the odds ratios for in-hospital mortality associated with surgery compared with embolization were 4.02 (Q < .001) and 4.38 (Q < .001), respectively. CONCLUSIONS Among patients presenting with blunt splenic injuries and compared with surgery, embolization was associated with shorter hospital LOS, shorter ICU LOS, and lower risk for mortality.
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Affiliation(s)
- Arrix L Ryce
- Wellstar Kennestone Regional Medical Center, Marietta, Georgia. https://twitter.com/A_Ryce
| | - Tarek Hanna
- Division of Emergency and Trauma Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia. https://twitter.com/ER_Rad_Hanna
| | - Randi Smith
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia; Marcus Trauma Center, Grady Memorial Hospital, Atlanta, Georgia. https://twitter.com/RandiSmithMD
| | - Richard Duszak
- Department of Radiology, University of Mississippi Medical Center, Jackson, Mississippi. https://twitter.com/RichDuszak
| | - Osman Ahmed
- Section of Interventional Radiology, Department of Radiology, University of Chicago Medicine, Chicago, Illinois. https://twitter.com/TheRealDoctorOs
| | - Minzhi Xing
- Gillings School of Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Nima Kokabi
- Division of Vascular Interventional Radiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
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Okada N, Mitani H, Mori T, Ueda M, Chosa K, Fukumoto W, Urata K, Hata R, Okazaki H, Hieda M, Awai K. Transarterial embolization to treat hemodynamically unstable trauma patients with splenic injuries: A retrospective multicenter observational study. Injury 2024:111768. [PMID: 39117521 DOI: 10.1016/j.injury.2024.111768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 07/30/2024] [Accepted: 08/01/2024] [Indexed: 08/10/2024]
Abstract
PURPOSE We described clinical outcomes for patients with blunt splenic injuries treated with transarterial embolization (TAE) based on their hemodynamic status. MATERIALS AND METHODS This is a retrospective two-center study of adult patients with splenic injuries who underwent emergency TAE between January 2011 and December 2022. Patients were divided into two groups; hemodynamically unstable (HDU) and hemodynamically stable (HDS) patients. HDU patients were defined as transient- or non-responders to fluid resuscitation and HDS as responders. When immediate laparotomy was not possible for HDU patients, angiography and embolization were performed. The primary outcome was the survival discharge rate. Rebleeding and splenectomy rate was also investigated. RESULTS Of 38 patients underwent emergency TAE for splenic trauma, 17 were HDU patients and 21 were HDS patients. The survival discharge rate was 88.2 % (15/17) in the HDU- and 100 % in HDS patients (p = 0.193). Rebleeding rate was 23.5 % (4/17) in HDU- and 5.0 % (1/21) in HDS patients (p = 0.15). Splenectomy was required for one HDU patient (5.9 %) for rebleeding. CONCLUSION The survival discharge rate of TAE for splenic trauma in HDU patients was acceptable with a low rate of splenectomy. Further comparative studies of TAE versus operative management in HDU patients are needed to prove the usefulness of TAE.
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Affiliation(s)
- Naohiro Okada
- Department of Diagnostic Radiology, Hiroshima Prefectural Hospital, 1-5-54, Ujinakanda, Minami-ku, Hiroshima, 734-8530, Japan; Hiroshima City North Medical Center Asa Citizens Hospital, 1-2-1, Kameyamaminami, Asakita-ku, Hiroshima, 731-0293, Japan
| | - Hidenori Mitani
- Department of Diagnostic Radiology, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Takuya Mori
- Department of Diagnostic Radiology, Hiroshima Prefectural Hospital, 1-5-54, Ujinakanda, Minami-ku, Hiroshima, 734-8530, Japan
| | - Masatomo Ueda
- Department of Diagnostic Radiology, Hiroshima Prefectural Hospital, 1-5-54, Ujinakanda, Minami-ku, Hiroshima, 734-8530, Japan
| | - Keigo Chosa
- Department of Diagnostic Radiology, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Wataru Fukumoto
- Department of Diagnostic Radiology, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kazuki Urata
- Department of Diagnostic Radiology, Hiroshima Prefectural Hospital, 1-5-54, Ujinakanda, Minami-ku, Hiroshima, 734-8530, Japan
| | - Ryoichiro Hata
- Department of Diagnostic Radiology, Hiroshima Prefectural Hospital, 1-5-54, Ujinakanda, Minami-ku, Hiroshima, 734-8530, Japan
| | - Hajime Okazaki
- Department of Diagnostic Radiology, Hiroshima Prefectural Hospital, 1-5-54, Ujinakanda, Minami-ku, Hiroshima, 734-8530, Japan
| | - Masashi Hieda
- Department of Diagnostic Radiology, Hiroshima Prefectural Hospital, 1-5-54, Ujinakanda, Minami-ku, Hiroshima, 734-8530, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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Annam A, Alexander ES, Cahill AM, Foley D, Green J, Himes EA, Johnson DT, Josephs S, Kulungowski AM, Leonard JC, Nance ML, Patel S, Pezeshkmehr A, Riggle K. Society of Interventional Radiology Position Statement on Endovascular Trauma Intervention in the Pediatric Population. J Vasc Interv Radiol 2024; 35:1104-1116.e19. [PMID: 38631607 DOI: 10.1016/j.jvir.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 04/19/2024] Open
Affiliation(s)
- Aparna Annam
- Division of Pediatric Radiology, Department of Radiology, University of Colorado, School of Medicine, Children's Hospital Colorado, Aurora, Colorado.
| | - Erica S Alexander
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anne Marie Cahill
- Department of Interventional Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - David Foley
- Department of Surgery, University of Louisville, School of Medicine, Norton Children's Hospital, Louisville, Kentucky
| | - Jared Green
- Joe DiMaggio Children's Hospital, Envision Radiology Associates of Hollywood, Pembroke Pines, Florida
| | | | | | - Shellie Josephs
- Department of Radiology, Texas Children's Hospital North Austin/Baylor College of Medicine, Austin, Texas
| | - Ann M Kulungowski
- Division of Pediatric Surgery, Department of Surgery, University of Colorado, School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Julie C Leonard
- Division of Emergency Medicine, Department of Pediatrics, Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Michael L Nance
- Department of Surgery, Division of Pediatric General and Thoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Amir Pezeshkmehr
- Department of Radiology, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
| | - Kevin Riggle
- Department of Surgery, University of Louisville, School of Medicine, Norton Children's Hospital, Louisville, Kentucky
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Campbell WA, Chick JFB, Shin DS, Makary MS. Value of interventional radiology and their contributions to modern medical systems. FRONTIERS IN RADIOLOGY 2024; 4:1403761. [PMID: 39086502 PMCID: PMC11288872 DOI: 10.3389/fradi.2024.1403761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 06/25/2024] [Indexed: 08/02/2024]
Abstract
Interventional radiology (IR) is a unique specialty that incorporates a diverse set of skills ranging from imaging, procedures, consultation, and patient management. Understanding how IR generates value to the healthcare system is important to review from various perspectives. IR specialists need to understand how to meet demands from various stakeholders to expand their practice improving patient care. Thus, this review discusses the domains of value contributed to medical systems and outlines the parameters of success. IR benefits five distinct parties: patients, practitioners, payers, employers, and innovators. Value to patients and providers is delivered through a wide set of diagnostic and therapeutic interventions. Payers and hospital systems financially benefit from the reduced cost in medical management secondary to fast patient recovery, outpatient procedures, fewer complications, and the prestige of offering diverse expertise for complex patients. Lastly, IR is a field of rapid innovation implementing new procedural technology and techniques. Overall, IR must actively advocate for further growth and influence in the medical field as their value continues to expand in multiple domains. Despite being a nascent specialty, IR has become indispensable to modern medical practice.
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Affiliation(s)
- Warren A. Campbell
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Virginia, Charlottesville, VA, United States
| | - Jeffrey F. B. Chick
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Washington, Seattle, WA, United States
| | - David S. Shin
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Southern California, Los Angeles, CA, United States
| | - Mina S. Makary
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
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Ruangvoravat L, Maung AA. Splenic angioembolization: still an important tool in the toolbox. Trauma Surg Acute Care Open 2024; 9:e001461. [PMID: 38646617 PMCID: PMC11029377 DOI: 10.1136/tsaco-2024-001461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024] Open
Affiliation(s)
- Lucy Ruangvoravat
- Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Adrian A Maung
- Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
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Okada I, Hifumi T, Yoneyama H, Inoue K, Seki S, Jimbo I, Takada H, Nagasawa K, Kohara S, Hishikawa T, Shiojima H, Hasegawa E, Morimoto K, Ichinose Y, Sato F, Kiriu N, Matsumoto J, Yokobori S. Survival benefits of interventional radiology and surgical teams collaboration during primary trauma surveys: a single-centre retrospective cohort study. BMC Emerg Med 2024; 24:65. [PMID: 38627690 PMCID: PMC11021012 DOI: 10.1186/s12873-024-00977-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 03/28/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND A team approach is essential for effective trauma management. Close collaboration between interventional radiologists and surgeons during the initial management of trauma patients is important for prompt and accurate trauma care. This study aimed to determine whether trauma patients benefit from close collaboration between interventional radiology (IR) and surgical teams during the primary trauma survey. METHODS A retrospective observational study was conducted between 2014 and 2021 at a single institution. Patients were assigned to an embolization group (EG), a surgery group (SG), or a combination group (CG) according to their treatment. The primary and secondary outcomes were survival at hospital discharge compared with the probability of survival (Ps) and the time course of treatment. RESULTS The analysis included 197 patients, consisting of 135 men and 62 women, with a median age of 56 [IQR, 38-72] years and an injury severity score of 20 [10-29]. The EG, SG, and CG included 114, 48, and 35 patients, respectively. Differences in organ injury patterns were observed between the three groups. In-hospital survival rates in all three groups were higher than the Ps. In particular, the survival rate in the CG was 15.5% higher than the Ps (95% CI: 7.5-23.6%; p < 0.001). In the CG, the median time for starting the initial procedure was 53 [37-79] min and the procedure times for IR and surgery were 48 [29-72] min and 63 [35-94] min, respectively. Those times were significantly shorter among three groups. CONCLUSION Close collaboration between IR and surgical teams, including the primary survey, improves the survival of severe trauma patients who require both IR procedures and surgeries by improving appropriate treatment selection and reducing the time process.
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Affiliation(s)
- Ichiro Okada
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-ku, 113-8603, Tokyo, Japan.
- Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256, 190-0014, Midoricho, Tachikawa city, Tokyo, Japan.
| | - Toru Hifumi
- Department of Emergency Medicine, St. Luke's International Hospital, 9-1, Akashicho, Chuo-ku, 104-8560, Tokyo, Japan
| | - Hisashi Yoneyama
- Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256, 190-0014, Midoricho, Tachikawa city, Tokyo, Japan
| | - Kazushige Inoue
- Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256, 190-0014, Midoricho, Tachikawa city, Tokyo, Japan
| | - Satoshi Seki
- Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256, 190-0014, Midoricho, Tachikawa city, Tokyo, Japan
| | - Ippei Jimbo
- Department of Anesthesia, Kyorin University Hospital, 6-20-2 Shinkawa, 181-8611, Mitaka city, Tokyo, Japan
| | - Hiroaki Takada
- Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256, 190-0014, Midoricho, Tachikawa city, Tokyo, Japan
| | - Koichi Nagasawa
- Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256, 190-0014, Midoricho, Tachikawa city, Tokyo, Japan
| | - Saiko Kohara
- Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256, 190-0014, Midoricho, Tachikawa city, Tokyo, Japan
| | - Tsuyoshi Hishikawa
- Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256, 190-0014, Midoricho, Tachikawa city, Tokyo, Japan
| | - Hiroki Shiojima
- Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256, 190-0014, Midoricho, Tachikawa city, Tokyo, Japan
| | - Eiju Hasegawa
- Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256, 190-0014, Midoricho, Tachikawa city, Tokyo, Japan
| | - Kohei Morimoto
- Department of Radiology, Kawasaki Municipal Tama Hospital, 1-30-37 Shukugawara, Tama-ku, 214-8525, Kawasaki city, Japan
| | - Yoshiaki Ichinose
- Department of Radiology, National Hospital Organization Disaster Medical Center, 3256, 190-0014, Midoricho, Tachikawa city, Tokyo, Japan
| | - Fumie Sato
- Department of Radiology, National Hospital Organization Disaster Medical Center, 3256, 190-0014, Midoricho, Tachikawa city, Tokyo, Japan
| | - Nobuaki Kiriu
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, 3-2, 359-8513, Namiki, Tokorozawa city, Saitama, Japan
| | - Junichi Matsumoto
- Department of Emergency and Critical Care Medicine, St Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, 216-8511, Kawasaki city, Japan
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-ku, 113-8603, Tokyo, Japan
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Suzuki T, Shiraishi A, Ito K, Otomo Y. Comparative effectiveness of angioembolization versus open surgery in patients with blunt splenic injury. Sci Rep 2024; 14:8800. [PMID: 38627581 PMCID: PMC11021531 DOI: 10.1038/s41598-024-59420-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 04/10/2024] [Indexed: 04/19/2024] Open
Abstract
The effectiveness and safety of transcatheter splenic artery embolization (SAE) compared to those of open surgery in patients with blunt splenic injury (BSI) remain unclear. This retrospective cohort-matched study utilized data from the Japan Trauma Data Bank recorded between 2004 and 2019. Patients with BSI who underwent SAE or open surgery were selected. A propensity score matching analysis was used to balance the baseline covariates and compare outcomes, including all-cause in-hospital mortality and spleen salvage. From 361,706 patients recorded in the data source, this study included 2,192 patients with BSI who underwent SAE or open surgery. A propensity score matching analysis was used to extract 377 matched pairs of patients. The in-hospital mortality rates (SAE, 11.6% vs. open surgery, 11.2%, adjusted relative risk (aRR): 0.64; 95% confidence interval [CI]: 0.38-1.09, p = 0.10) were similar in both the groups. However, spleen salvage was significantly less achieved in the open surgery group than in the SAE group (SAE, 87.1% vs. open surgery, 32.1%; aRR: 2.84, 95%CI: 2.29-3.51, p < 0.001). Survival rates did not significantly differ between BSI patients undergoing SAE and those undergoing open surgery. Nonetheless, SAE was notably associated with a higher likelihood of successful spleen salvage.
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Affiliation(s)
- Toshinao Suzuki
- Department of Anesthesiology, Kimitsu Chuo Hospital, Chiba, Japan
- Emergency and Trauma Center, Kameda Medical Center, 929 Higashicho, Kamogawa, Chiba, 296-8602, Japan
- Interventional Radiology Center, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Atsushi Shiraishi
- Emergency and Trauma Center, Kameda Medical Center, 929 Higashicho, Kamogawa, Chiba, 296-8602, Japan.
| | - Kensuke Ito
- Emergency and Trauma Center, Kameda Medical Center, 929 Higashicho, Kamogawa, Chiba, 296-8602, Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan
- National Disaster Medical Center, Tokyo, Japan
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10
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Giurazza F, Corvino F, Pane F, Di Serafino M, Niola R. Combined DSA- and US-guided management of acute bleeding: effectiveness of percutaneous glue embolization in six cases. J Ultrasound 2024; 27:179-184. [PMID: 37162728 PMCID: PMC10908745 DOI: 10.1007/s40477-023-00785-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 03/14/2023] [Indexed: 05/11/2023] Open
Abstract
AIMS This study aims to report on safety and effectiveness of glue embolization of acute hemorrhages performed by US-guided percutaneous direct puncture, in patients where the standard endovascular approach is technically unfavourable. METHODS In this single center retrospective analysis, patients affected by traumatic or non traumatic acute hemorrhages were treated with glue embolization technically performed by US-guided direct puncture. Patients suffered from active bleeding detected at contrast-enhanced Computer Tomography and confirmed at Digital Subtracted Arteriography, with concomitant hemoglobin drop and blood pressure reduction. Six patients were reviewed; hemorrhages occurred in liver parenchima (1), gallbladder (1) and lower limbs (4). Bleedings etiologies were post-traumatic (5) and inflammatory (1); four had extraluminal blushes while 2 were pseudoaneurysms. In five cases (4 limbs and 1 hepatic bleedings) the direct-puncture approach was adopted because of technically unfavourable vascular anatomy for superselective embolization; in one case (cystic artery pseudoaneurysm), an endovascular embolization would entail a high risk of gallbladder ischemia because of its terminal arterial supply. Technical success was defined disappearance of bleeding signs at last arteriography; clinical success was considered stabilization and/or improvement of hemoglobin values and arterial pressure without additional interventions. RESULTS Both technical and clinical successes were obtained in 100% of the cases without major complications. No needle occlusion occurred during glue injection. CONCLUSIONS In this study percutaneous US-guided embolization by direct puncture was a safe and effective approach to manage acute bleedings; it could be considered as an alternative in patients with unfavourable vascular anatomy for the standard catheter-directed endovascular embolization.
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Affiliation(s)
- Francesco Giurazza
- Department of Vascular and Interventional Radiology, Cardarelli Hopistal, Via Cardarelli 9, 80131, Naples, Italy.
| | - Fabio Corvino
- Department of Vascular and Interventional Radiology, Cardarelli Hopistal, Via Cardarelli 9, 80131, Naples, Italy
| | - Francesco Pane
- Department of Vascular and Interventional Radiology, Cardarelli Hopistal, Via Cardarelli 9, 80131, Naples, Italy
| | - Marco Di Serafino
- Department of Radiology, Cardarelli Hopistal, Via Cardarelli 9, 80131, Naples, Italy
| | - Raffaella Niola
- Department of Vascular and Interventional Radiology, Cardarelli Hopistal, Via Cardarelli 9, 80131, Naples, Italy
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Yebes A, Martinez-Piñeiro L. Re: Grade V Renal Trauma Management: Results from the Multi-institutional Genito-urinary Trauma Study. Eur Urol 2024; 85:305. [PMID: 37977961 DOI: 10.1016/j.eururo.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/02/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Alvaro Yebes
- Department of Urology. La Paz University Hospital, Madrid, Spain.
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Adams-McGavin RC, Tafur M, Vlachou PA, Wu M, Brassil M, Crivellaro P, Lin HM, Gomez D, Colak E. Interrater Agreement of CT Grading of Blunt Splenic Injuries: Does the AAST Grading Need to Be Reimagined? Can Assoc Radiol J 2024; 75:171-177. [PMID: 37405424 DOI: 10.1177/08465371231184425] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023] Open
Abstract
Introduction: The Revised Organ Injury Scale (OIS) of the American Association for Surgery of Trauma (AAST) is the most widely accepted classification of splenic trauma. The objective of this study was to evaluate inter-rater agreement for CT grading of blunt splenic injuries. Methods: CT scans in adult patients with splenic injuries at a level 1 trauma centre were independently graded by 5 fellowship trained abdominal radiologists using the AAST OIS for splenic injuries - 2018 revision. The inter-rater agreement for AAST CT injury score, as well as low-grade (IIII) versus high-grade (IV-V) splenic injury was assessed. Disagreement in two key clinical scenarios (no injury versus injury, and high versus low grade) were qualitatively reviewed to identify possible sources of disagreement. Results: A total of 610 examinations were included. The inter-rater absolute agreement was low (Fleiss kappa statistic 0.38, P < 0.001), but improved when comparing agreement between low and high grade injuries (Fleiss kappa statistic of 0.77, P < .001). There were 34 cases (5.6%) of minimum two-rater disagreement about no injury vs injury (AAST grade ≥ I). There were 46 cases (7.5%) of minimum two-rater disagreement of low grade (AAST grade I-III) versus high grade (AAST grade IV-V) injuries. Likely sources of disagreement were interpretation of clefts versus lacerations, peri-splenic fluid versus subcapsular hematoma, application of adding multiple low grade injuries to higher grade injuries, and identification of subtle vascular injuries. Conclusion: There is low absolute agreement in grading of splenic injuries using the existing AAST OIS for splenic injuries.
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Affiliation(s)
- R Chris Adams-McGavin
- Department of Surgery, Temetry Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Monica Tafur
- Department of Medical Imaging, Unity Health Toronto, St Michael's Hospital, Toronto, ON, Canada
- Department of Medical Imaging, Temetry Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Paraskevi A Vlachou
- Department of Medical Imaging, Unity Health Toronto, St Michael's Hospital, Toronto, ON, Canada
- Department of Medical Imaging, Temetry Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Matthew Wu
- Department of Medical Imaging, Unity Health Toronto, St Michael's Hospital, Toronto, ON, Canada
- Department of Medical Imaging, Temetry Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michael Brassil
- Department of Medical Imaging, Unity Health Toronto, St Michael's Hospital, Toronto, ON, Canada
- Department of Medical Imaging, Temetry Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Priscila Crivellaro
- Department of Medical Imaging, Unity Health Toronto, St Michael's Hospital, Toronto, ON, Canada
- Department of Medical Imaging, Temetry Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Hui-Ming Lin
- Department of Medical Imaging, Unity Health Toronto, St Michael's Hospital, Toronto, ON, Canada
| | - David Gomez
- Department of Surgery, Temetry Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
- Division of General Surgery, Unity Health Toronto, St Michael's Hospital, Toronto, ON, Canada
| | - Errol Colak
- Department of Medical Imaging, Unity Health Toronto, St Michael's Hospital, Toronto, ON, Canada
- Department of Medical Imaging, Temetry Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
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13
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Lanier MH, Mellnick VM. Invited Commentary: Agreement for Blunt Splenic Injuries Has Room for Improvement. Can Assoc Radiol J 2024; 75:26-27. [PMID: 37531212 DOI: 10.1177/08465371231189681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Affiliation(s)
- M Hunter Lanier
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - Vincent M Mellnick
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
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14
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Cyphers ED, Acord MR, Gaballah M, Schoeman S, Nance ML, Srinivasan A, Vatsky S, Krishnamurthy G, Escobar F, Cajigas-Loyola S, Cahill AM. Embolization for pediatric trauma. Pediatr Radiol 2024; 54:181-196. [PMID: 37962604 DOI: 10.1007/s00247-023-05803-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 10/23/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND The management of pediatric trauma with trans-arterial embolization is uncommon, even in level 1 trauma centers; hence, there is a dearth of literature on this subject compared to the adult experience. OBJECTIVE To describe a single-center, level 1 trauma center experience with arterial embolization for pediatric trauma. MATERIALS AND METHODS A retrospective review was performed to identify demographics, transfusion requirements, pre-procedure imaging, procedural details, adverse events, and arterial embolization outcomes over a 19-year period. Twenty children (age 4.5 months to 17 years, median 13.5 years; weight 3.6 to 108 kg, median 53 kg) were included. Technical success was defined as angiographic resolution of the bleeding-related abnormality on post-embolization angiography or successful empiric embolization in the absence of an angiographic finding. Clinical success was defined as not requiring additional intervention after embolization. RESULTS Seventy-five percent (n=15/20) of patients required red blood cell transfusions prior to embolization with a mean volume replacement 64 ml/kg (range 12-166 ml/kg) and the median time from injury to intervention was 3 days (range 0-16 days). Technical success was achieved in 100% (20/20) of children while clinical success was achieved in 80% (n=16/20). For the 4 children (20%) with continued bleeding following initial embolization, 2 underwent repeat embolization, 1 underwent surgery, and 1 underwent repeat embolization and surgery. Mortality prior to discharge was 15% (n=3). A post-embolization mild adverse event included one groin hematoma, while a severe adverse event included one common iliac artery pseudoaneurysm requiring open surgical ligation. CONCLUSIONS In this single-center experience, arterial embolization for hemorrhage control in children after trauma is feasible but can be challenging and the clinical failure rate of 20% in this series reflects this complexity. Standardization of pre-embolization trauma assessment parameters and embolic techniques may improve outcomes.
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Affiliation(s)
- Eric D Cyphers
- Division of Interventional Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, USA.
| | - Michael R Acord
- Division of Interventional Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Marian Gaballah
- Department of Radiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Sean Schoeman
- Division of Interventional Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, USA
| | - Michael L Nance
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of General Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Abhay Srinivasan
- Division of Interventional Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Seth Vatsky
- Division of Interventional Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ganesh Krishnamurthy
- Division of Interventional Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Fernando Escobar
- Division of Interventional Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Stephanie Cajigas-Loyola
- Division of Interventional Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Anne Marie Cahill
- Division of Interventional Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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15
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Tsurkan VA, Shabunin AV, Grekov DN, Bedin VV, Arablinskiy AV, Yakimov LA, Shikov DV, Ageeva AA. [Endovascular technologies in the treatment of patients with blunt abdominal trauma]. Khirurgiia (Mosk) 2024:108-117. [PMID: 39140952 DOI: 10.17116/hirurgia2024081108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
Trauma is one of the leading causes of disability and mortality in working-age population. Abdominal injuries comprise 20-30% of traumas. Uncontrolled bleeding is the main cause of death in 30-40% of patients. Among abdominal organs, spleen is most often damaged due to fragile structure and subcostal localization. In the last two decades, therapeutic management has become preferable in patients with abdominal trauma and stable hemodynamic parameters. In addition to clinical examination, standard laboratory tests and ultrasound, as well as contrast-enhanced CT of the abdomen should be included in diagnostic algorithm to identify all traumatic injuries and assess severity of abdominal damage. Development of interventional radiological technologies improved preservation of damaged organs. Endovascular embolization can be performed selectively according to indications (leakage, false aneurysm, arteriovenous anastomosis) and considered for severe damage to the liver and spleen, hemoperitoneum or severe polytrauma. Embolization is essential in complex treatment of traumatic vascular injuries of parenchymal abdominal organs. We reviewed modern principles and methods of intra-arterial embolization for the treatment of patients with traumatic injuries of the liver and spleen.
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Affiliation(s)
- V A Tsurkan
- Botkin Moscow City Clinical Hospital, Moscow, Russia
| | - A V Shabunin
- Botkin Moscow City Clinical Hospital, Moscow, Russia
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - D N Grekov
- Botkin Moscow City Clinical Hospital, Moscow, Russia
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - V V Bedin
- Botkin Moscow City Clinical Hospital, Moscow, Russia
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - A V Arablinskiy
- Botkin Moscow City Clinical Hospital, Moscow, Russia
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - L A Yakimov
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - D V Shikov
- Botkin Moscow City Clinical Hospital, Moscow, Russia
| | - A A Ageeva
- Botkin Moscow City Clinical Hospital, Moscow, Russia
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16
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Yu Q, Lionberg A, Zane K, Ungchusri E, Du J, Nijhawan K, Clarey A, Navuluri R, Ahmed O, Prakash P, Leef J, Funaki B. Transarterial interventions in civilian gunshot wound injury: experience from a level-1 trauma center. CVIR Endovasc 2023; 6:47. [PMID: 37843596 PMCID: PMC10579195 DOI: 10.1186/s42155-023-00396-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/04/2023] [Indexed: 10/17/2023] Open
Abstract
PURPOSE To assess the effectiveness of trans-arterial vascular interventions in treatment of civilian gunshot wounds (GSW). MATERIALS AND METHODS A retrospective review was performed at a level-1 trauma center to include 46 consecutive adults admitted due to GSW related hemorrhage and treated with endovascular interventions from July 2018 to July 2022. Patient demographics and procedural metrics were retrieved. Primary outcomes of interest include technical success and in-hospital mortality. Factors of mortality were assessed using a logistic regression model. RESULTS Twenty-one patients were brought to the endovascular suite directly (endovascular group) from the trauma bay and 25 patients after treatment in the operating room (OR group). The OR group had higher hemodynamic instability (48.0% vs 19.0%, p = 0.040), lower hemoglobin (12.9 vs 10.1, p = 0.001) and platelet counts (235.2 vs 155.1, p = 0.003), and worse Acute Physiology and Chronic Health Evaluation (APACHE) score (4.1 vs 10.2, p < 0.0001) at the time of initial presentation. Technical success was achieved in all 40 cases in which targeted embolization was attempted (100%). Empiric embolization was performed in 6/46 (13.0%) patients based on computed tomographic angiogram (CTA) and operative findings. Stent-grafts were placed in 3 patients for subclavian artery injuries. Availability of pre-intervention CTA was associated with shorter fluoroscopy time (19.8 ± 12.1 vs 30.7 ± 18.6 min, p = 0.030). A total of 41 patients were discharged in stable condition (89.1%). Hollow organ injury was associated with mortality (p = 0.039). CONCLUSION Endovascular embolization and stenting were effective in managing hemorrhage due to GSW in a carefully selected population. Hollow organ injury was a statistically significant predictor of mortality. Pre-intervention CTA enabled targeted, shorter and equally effective procedures.
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Affiliation(s)
- Qian Yu
- Department of Radiology, University of Chicago Medical Center, 5841 S Maryland Ave, Chicago, IL, 60637, USA.
| | - Alex Lionberg
- Department of Radiology, University of Chicago Medical Center, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - Kylie Zane
- Department of Radiology, University of Chicago Medical Center, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - Ethan Ungchusri
- Department of Radiology, University of Chicago Medical Center, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - Jonathan Du
- Department of Radiology, University of Chicago Medical Center, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - Karan Nijhawan
- Department of Radiology, University of Chicago Medical Center, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - Austin Clarey
- Department of Radiology, University of Chicago Medical Center, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - Rakesh Navuluri
- Department of Radiology, University of Chicago Medical Center, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - Osman Ahmed
- Department of Radiology, University of Chicago Medical Center, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - Priya Prakash
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, 60637, USA
| | - Jeffrey Leef
- Department of Radiology, University of Chicago Medical Center, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - Brian Funaki
- Department of Radiology, University of Chicago Medical Center, 5841 S Maryland Ave, Chicago, IL, 60637, USA
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17
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Minici R, Mercurio M, Guzzardi G, Venturini M, Fontana F, Brunese L, Guerriero P, Serra R, Piacentino F, Spinetta M, Zappia L, Costa D, Coppola A, Galasso O, Laganà D. Transcatheter Arterial Embolization for Bleeding Related to Pelvic Trauma: Comparison of Technical and Clinical Results between Hemodynamically Stable and Unstable Patients. Tomography 2023; 9:1660-1682. [PMID: 37736986 PMCID: PMC10514840 DOI: 10.3390/tomography9050133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/11/2023] [Accepted: 08/23/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Endovascular intervention is now the primary line of therapy for arterial injury brought on by pelvic trauma since it can significantly reduce considerable morbidity associated with surgery and can swiftly access and control bleeding sites. Despite international guidelines and widespread awareness of the role of angioembolization in clinical practice, robust evidence comparing the outcomes of angioembolization in hemodynamically stable and unstable patients is still lacking. This study aims to directly compare the outcomes of angioembolization for the treatment of pelvic traumatic arterial injury in patients with hemodynamic stability vs. hemodynamic instability. METHODS In our multicenter retrospective investigation, we analyzed data from consecutive patients who underwent, from January 2020 to May 2023, angioembolization for traumatic pelvic arterial injury. RESULTS In total, 116 angioembolizations were performed. Gelatin sponges (56.9%) and coils (25.9%) were the most widely used embolic agents. The technical and clinical success rates were 100% and 91.4%, respectively. No statistically significant differences were observed between the two groups in terms of technical success, clinical success, procedure-related complication rate, or 30-day bleeding-related mortality. CONCLUSIONS Angioembolization is an effective and safe option for the management of traumatic pelvic arterial lesions even in hemodynamically unstable patients, despite technical variations such as greater use of prophylactic angioembolization.
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Affiliation(s)
- Roberto Minici
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy; (L.Z.); (D.L.)
| | - Michele Mercurio
- Department of Orthopaedic and Trauma Surgery, Magna Græcia University, Dulbecco University Hospital, 88100 Catanzaro, Italy; (M.M.); (O.G.)
| | - Giuseppe Guzzardi
- Radiology Unit, Maggiore della Carità University Hospital, 28100 Novara, Italy; (G.G.); (M.S.)
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy; (M.V.); (F.F.); (F.P.); (A.C.)
| | - Federico Fontana
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy; (M.V.); (F.F.); (F.P.); (A.C.)
| | - Luca Brunese
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy; (L.B.); (P.G.)
| | - Pasquale Guerriero
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy; (L.B.); (P.G.)
| | - Raffaele Serra
- Vascular Surgery Unit, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Dulbecco University Hospital, 88100 Catanzaro, Italy;
| | - Filippo Piacentino
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy; (M.V.); (F.F.); (F.P.); (A.C.)
| | - Marco Spinetta
- Radiology Unit, Maggiore della Carità University Hospital, 28100 Novara, Italy; (G.G.); (M.S.)
| | - Lorenzo Zappia
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy; (L.Z.); (D.L.)
| | - Davide Costa
- Department of Law, Economics and Sociology, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy;
| | - Andrea Coppola
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy; (M.V.); (F.F.); (F.P.); (A.C.)
| | - MGJR Research Team
- Magna Graecia Junior Radiologists Research Team, 88100 Catanzaro, Italy;
| | - Olimpio Galasso
- Department of Orthopaedic and Trauma Surgery, Magna Græcia University, Dulbecco University Hospital, 88100 Catanzaro, Italy; (M.M.); (O.G.)
| | - Domenico Laganà
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy; (L.Z.); (D.L.)
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
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18
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Lee H, Kwon H, Kim CW, Hwangbo L. [Intervention for Chest Trauma and Large Vessel Injury]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:809-823. [PMID: 37559800 PMCID: PMC10407064 DOI: 10.3348/jksr.2023.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/23/2023] [Accepted: 06/20/2023] [Indexed: 08/11/2023]
Abstract
Trauma is an injury to the body that involves multiple anatomical and pathophysiological changes caused by forces acting from outside the body. The number of patients with trauma is increasing as our society becomes more sophisticated. The importance and demand of traumatology are growing due to the development and spread of treatment and diagnostic technologies. In particular, damage to the large blood vessels of the chest can be life-threatening, and the sequelae are often severe; therefore, diagnostic and therapeutic methods are becoming increasingly important. Trauma to non-aortic vessels of the thorax and aorta results in varying degrees of physical damage depending on the mechanism of the accident and anatomical damage involved. The main damage is hemorrhage from non-aortic vessels of the thorax and aorta, accompanied by hemodynamic instability and coagulation disorders, which can be life-threatening. Immediate diagnosis and rapid therapeutic access can often improve the prognosis. The treatment of trauma can be surgical or interventional, depending on the patient's condition. Among them, interventional procedures are increasingly gaining popularity owing to their convenience, rapidity, and high therapeutic effectiveness, with increasing use in more trauma centers worldwide. Typical interventional procedures for patients with thoracic trauma include embolization for non-aortic injuries and thoracic endovascular aortic repair for aortic injuries. These procedures have many advantages over surgical treatments, such as fewer internal or surgical side effects, and can be performed more quickly than surgical procedures, contributing to improved outcomes for patients with trauma.
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19
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Kim JH. [Role of Interventional Radiologists in Trauma Centers]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:784-791. [PMID: 37559809 PMCID: PMC10407069 DOI: 10.3348/jksr.2023.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/06/2023] [Accepted: 06/30/2023] [Indexed: 08/11/2023]
Abstract
Based on statistics available in Korea, trauma centers play a critical role in treatment of patients with trauma. Interventional radiologists in trauma centers perform various procedures, including embolization, which constitutes the basic treatment for control of hemorrhage, although interventions such as stent graft insertion may also be used. Although emergency interventional procedures have been used conventionally, rapid and effective hemorrhage control is important in patients with trauma. Therefore, it is important to accurately understand and implement the concept of damage control interventional radiology, which has gained attention in recent times, to reduce preventable trauma-induced mortality rates.
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20
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Hörer TM, Ierardi AM, Carriero S, Lanza C, Carrafiello G, McGreevy DT. Emergent vessel embolization for major traumatic and non-traumatic hemorrhage: Indications, tools and outcomes. Semin Vasc Surg 2023; 36:283-299. [PMID: 37330241 DOI: 10.1053/j.semvascsurg.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 06/19/2023]
Abstract
Endovascular embolization of bleeding vessels in trauma and non-trauma patients is frequently used and is an important tool for bleeding control. It is included in the EVTM (endovascular resuscitation and trauma management) concept and its use in patients with hemodynamic instability is increasing. When the correct embolization tool is chosen, a dedicated multidisciplinary team can rapidly and effectively achieve bleeding control. In this article, we will describe the current use and possibilities for embolization of major hemorrhage (traumatic and non-traumatic) and the published data supporting these techniques as part of the EVTM concept.
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Affiliation(s)
- Tal M Hörer
- Department of Cardiothoracic and Vascular Surgery, Faculty of Life Sciences, Örebro University Hospital and Örebro University, Södra Grev Rosengatan, 701 85 Örebro, Sweden; Department of Surgery, Faculty of Life Sciences, Örebro University Hospital and Örebro University, Örebro, Sweden; Carmel Lady Davis Hospital, Technion Medical Faculty, Haifa, Israel.
| | - Anna Maria Ierardi
- Radiology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Serena Carriero
- Post Graduate School of Radiology, University of Milan, Milan, Italy
| | - Carolina Lanza
- Post Graduate School of Radiology, University of Milan, Milan, Italy
| | - Gianpaolo Carrafiello
- Radiology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - David T McGreevy
- Department of Cardiothoracic and Vascular Surgery, Faculty of Life Sciences, Örebro University Hospital and Örebro University, Södra Grev Rosengatan, 701 85 Örebro, Sweden
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21
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Sammoud S, Ghelfi J, Barbois S, Beregi JP, Arvieux C, Frandon J. Preventive Proximal Splenic Artery Embolization for High-Grade AAST-OIS Adult Spleen Trauma without Vascular Anomaly on the Initial CT Scan: Technical Aspect, Safety, and Efficacy-An Ancillary Study. J Pers Med 2023; 13:889. [PMID: 37373879 DOI: 10.3390/jpm13060889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/18/2023] [Accepted: 05/18/2023] [Indexed: 06/29/2023] Open
Abstract
The spleen is the most commonly injured organ in blunt abdominal trauma. Its management depends on hemodynamic stability. According to the American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS ≥ 3), stable patients with high-grade splenic injuries may benefit from preventive proximal splenic artery embolization (PPSAE). This ancillary study, using the SPLASH multicenter randomized prospective cohort, evaluated the feasibility, safety, and efficacy of PPSAE in patients with high-grade blunt splenic trauma without vascular anomaly on the initial CT scan. All patients included were over 18 years old, had high-grade splenic trauma (≥AAST-OIS 3 + hemoperitoneum) without vascular anomaly on the initial CT scan, received PPSAE, and had a CT scan at one month. Technical aspects, efficacy, and one-month splenic salvage were studied. Fifty-seven patients were reviewed. Technical efficacy was 94% with only four proximal embolization failures due to distal coil migration. Six patients (10.5%) underwent combined embolization (distal + proximal) due to active bleeding or focal arterial anomaly discovered during embolization. The mean procedure time was 56.5 min (SD = 38.1 min). Embolization was performed with an Amplatzer™ vascular plug in 28 patients (49.1%), a Penumbra occlusion device in 18 patients (31.6%), and microcoils in 11 patients (19.3%). There were two hematomas (3.5%) at the puncture site without clinical consequences. There were no rescue splenectomies. Two patients were re-embolized, one on Day 6 for an active leak and one on Day 30 for a secondary aneurysm. Primary clinical efficacy was, therefore, 96%. There were no splenic abscesses or pancreatic necroses. The splenic salvage rate on Day 30 was 94%, while only three patients (5.2%) had less than 50% vascularized splenic parenchyma. PPSAE is a rapid, efficient, and safe procedure that can prevent splenectomy in high-grade spleen trauma (AAST-OIS) ≥ 3 with high splenic salvage rates.
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Affiliation(s)
- Skander Sammoud
- Department of Radiology, Nîmes Carémeau University Hospital, 30900 Nimes, France
| | - Julien Ghelfi
- Institute for Advanced Biosciences, Inserm U 1209, CNRS UMR 5309, Université Grenoble Alpes, 38000 Grenoble, France
- Department of Radiology, Grenoble-Alpes University Hospital, 38000 Grenoble, France
| | - Sandrine Barbois
- Department of Digestive Surgery, University Hospital Grenoble Alpes, 38043 Grenoble, France
| | - Jean-Paul Beregi
- Department of Radiology, Nîmes Carémeau University Hospital, 30900 Nimes, France
| | - Catherine Arvieux
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, 38043 Grenoble, France
| | - Julien Frandon
- Department of Radiology, Nîmes Carémeau University Hospital, 30900 Nimes, France
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Conroy S, Griffin J, Cumberbatch M, Pathak S. Acute haemorrhage from a large renal epithelioid angiomyolipoma: diagnostic and management considerations in a teenage patient with a rare cancer. BMJ Case Rep 2023; 16:e252351. [PMID: 37202109 PMCID: PMC10201216 DOI: 10.1136/bcr-2022-252351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Acute renal haemorrhage is a life-threatening condition that is complicated in the context of renal malignancy. Here, we present the case of a teenage male presenting acutely with a large, bleeding renal epithelioid angiomyolipoma (EAML) of the kidney-a rare cancer, which is part of the perivascular epithelioid cell tumour family. The patient was managed acutely with prompt resuscitation, transfer to a centre of expertise and haemorrhagic control using radiologically guided endovascular techniques; this subsequently permitted an oncologically sound procedure (radical nephrectomy, inferior vena cava thrombectomy and lymphadenectomy) to be performed within 24 hours. The description and discussion around this unique case summarises the patient's clinical journey, while exploring the current literature surrounding diagnosis and outcomes of patients with renal EAMLs.
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Affiliation(s)
- Samantha Conroy
- Academic Unit of Urology, Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
- Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jon Griffin
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
- Department of Pathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Marcus Cumberbatch
- Academic Unit of Urology, Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
- Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Liu J, Wang S, Xue X, Hu T, Peng X, Huang J, Zhou S. Experimental study of the effects of absorbable gelatin sponge and non‑absorbable polyvinyl alcohol particle material used in transcatheter arterial embolization on liver tissues. Exp Ther Med 2023; 25:229. [PMID: 37114170 PMCID: PMC10126803 DOI: 10.3892/etm.2023.11928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/03/2023] [Indexed: 04/29/2023] Open
Abstract
Hepatic trauma is a leading cause of death in major abdominal trauma, and transcatheter arterial embolization has been widely used to treat it. However, there is limited research on whether absorbable gelatin sponge (AGS) and non-absorbable polyvinyl alcohol particles (PVA) have different effects on liver tissue, making it an important area of exploration. The present study investigated this issue using animal experiments by performing transhepatic arterial embolization with AGS and PVA. The effects on normal liver tissue in rabbits were examined by detecting liver function and inflammatory indexes, conducting histopathological examination, and using western blotting to detect apoptotic proteins. There were significant differences between the AGS and PVA groups after embolization. The AGS group exhibited a trend of improvement at ~1 week after embolization, and all indicators were statistically different until day 21 compared with the PVA group. The AGS group exhibited improved repair of hepatocytes and the biliary system based on H&E staining, while the PVA group exhibited more severe necrosis of the hepatocytes and biliary system around the embolization site. The western blotting results indicated that the Bcl-2/Bax ratio decreased on day 1 and day 3, and then rebounded in the AGS group on days 7 and 21, demonstrating gradual repair of hepatocytes compared with the PVA group.
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Affiliation(s)
- Jianping Liu
- Department of General Surgery, Dongnan Hospital of Xiamen University, School of Medicine, Xiamen University, Zhangzhou, Fujian 363000, P.R. China
| | - Shaoyi Wang
- Department of General Surgery, Dongnan Hospital of Xiamen University, School of Medicine, Xiamen University, Zhangzhou, Fujian 363000, P.R. China
| | - Xiaojun Xue
- Department of General Surgery, Dongnan Hospital of Xiamen University, School of Medicine, Xiamen University, Zhangzhou, Fujian 363000, P.R. China
| | - Tiansong Hu
- Department of General Surgery, Dongnan Hospital of Xiamen University, School of Medicine, Xiamen University, Zhangzhou, Fujian 363000, P.R. China
| | - Xinjian Peng
- Department of General Surgery, Dongnan Hospital of Xiamen University, School of Medicine, Xiamen University, Zhangzhou, Fujian 363000, P.R. China
| | - Junhao Huang
- Department of General Surgery, Dongnan Hospital of Xiamen University, School of Medicine, Xiamen University, Zhangzhou, Fujian 363000, P.R. China
| | - Song Zhou
- Department of General Surgery, Dongnan Hospital of Xiamen University, School of Medicine, Xiamen University, Zhangzhou, Fujian 363000, P.R. China
- Correspondence to: Professor Song Zhou, Department of General Surgery, Dongnan Hospital of Xiamen University, School of Medicine, Xiamen University, 269 Zhanghua Middle Road, Zhangzhou, Fujian 363000, P.R. China
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Wahood W, Badar W, Funaki B, Leef JA, Ahmed O. Comparing Outcomes in Transcatheter Embolization for the Management of Penetrating versus Blunt Trauma. THE ARAB JOURNAL OF INTERVENTIONAL RADIOLOGY 2022. [DOI: 10.1055/s-0042-1758041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Purpose This article assesses potential factors associated with successful embolization and/or mortality benefit among patients with penetrating (PT) compared to those with blunt abdominal trauma (BT) undergoing emergent angiography.
Methods A retrospective study of arterial embolization for BT and PT at a tertiary care academic center in an urban setting between 2018 and 2020 was conducted. Fischer's exact and Student's t-tests were used to assess differences between PT and BT, regarding technical success, in-hospital mortality, number of vessels embolized, and requirement of Operating Room (OR) for bleeding control after embolization.
Results Forty-three patients underwent embolization. Twenty-three presented with BT versus 20 with PT. There was no difference in the rate of success between the two groups (91.3% vs. 100%; p = 0.49). No difference was observed in mean days of survival among BT and PT patients treated by embolization (mean [standard deviation]: 13.7 [2.6] vs. 19.1 [2.79] days; p = 0.160). There was no difference in mortality between the two groups (13.0% vs. 10.5%; p = 1.00). Mean number of vessels embolized was higher in the BT group compared to PT (2.26 [1.32] vs. 1.44 [1.03], p = 0.044). The rate of BT patients who required subsequent OR intervention for hemorrhage control after embolization was similar to those with PT (8.7% vs. 10.5%; p = 0.84).
Conclusion The rate of mortality, technical success, and requirement of subsequent OR intervention for hemorrhage control was comparable between BT and PT. BT was associated with a higher mean number of vessels embolized compared to PT. Our case series may provide insight in the use of embolization for PT, but further investigation is needed with larger cohorts.
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Affiliation(s)
- Waseem Wahood
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Davie, Florida, United States
| | - Wali Badar
- Section of Interventional Radiology, Department of Radiology, University of Illinois at Chicago, Chicago, Illinois, United States
| | - Brian Funaki
- Section of Interventional Radiology, Department of Radiology, University of Chicago, Chicago, Illinois, United States
| | - Jeffrey A. Leef
- Section of Interventional Radiology, Department of Radiology, University of Chicago, Chicago, Illinois, United States
| | - Osman Ahmed
- Section of Interventional Radiology, Department of Radiology, University of Chicago, Chicago, Illinois, United States
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25
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Al-Sharydah AM. Predicting Suitable Percutaneous Endovascular Arterial Embolization for Traumatic Abdominopelvic Injuries: A Retrospective Cohort Study. Open Access Emerg Med 2022; 14:545-556. [PMID: 36212089 PMCID: PMC9534156 DOI: 10.2147/oaem.s376819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/31/2022] [Indexed: 11/29/2022] Open
Abstract
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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Affiliation(s)
- Abdulaziz Mohammad Al-Sharydah
- Diagnostic and Interventional Radiology Department, Imam Abdulrahman Bin Faisal University, College of Medicine, King Fahd Hospital of the University, Al-Khobar City, Eastern Province, Saudi Arabia
- Correspondence: Abdulaziz Mohammad Al-Sharydah, Diagnostic and Interventional Radiology Department, Imam Abdulrahman Bin Faisal University, College of Medicine, King Fahd Hospital of the University, PO Box: 31952, Al-Khobar City, Eastern Province, 4398, Saudi Arabia, Fax +966 013 8676697, Email
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26
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Annam A, Josephs S, Johnson T, Kulungowski AM, Towbin RB, Cahill AM. Pediatric trauma and the role of the interventional radiologist. Emerg Radiol 2022; 29:903-914. [PMID: 35678950 DOI: 10.1007/s10140-022-02067-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 05/30/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE While interventional radiologists occupy a critical role in adult trauma management, the role of interventionalist in pediatric trauma continues to evolve. The indications for transarterial embolization (TAE) are significantly different in pediatric patients in whom non-operative management (NOM) has a much more prominent role than in adults. Contrast extravasation on imaging may not require acute surgical or interventional management as it would in an adult. There are also areas in which pediatric interventional radiology is increasingly useful such as pelvic TAE in failed management, or splenic embolization to treat bleeding without the loss of splenic function inherent to surgical splenectomy. The rapid evolution of techniques and devices in pediatric patients is also changing what interventions are possible in pediatric trauma management which necessitates frequent reassessment of the guidelines and interventional radiology's role in caring for these patients. CONCLUSION This review seeks to consolidate the recent literature to describe the evolving role of the interventional radiologist in pediatric trauma management.
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Affiliation(s)
- Aparna Annam
- Division of Pediatric Radiology, Department of Radiology, University of Colorado, Children's Hospital Colorado, 13123 East 16th Avenue, Aurora, CO, 80045, USA.
| | - Shellie Josephs
- Department of Pediatric Radiology, Lucile Packard Children's Hospital, Stanford Medicine, Palo Alto, CA, USA
| | - Thor Johnson
- Division of Vascular and Interventional Radiology, Medical University of South Carolina, Mount Pleasant, SC, USA
| | - Ann M Kulungowski
- Division of Pediatric Surgery, Department of Surgery, University of Colorado, Children's Hospital Colorado, Aurora, CO, USA
| | - Richard B Towbin
- Emeritus Radiologist-in-Chief at Phoenix Children's Hospital, Phoenix, USA
| | - Anne Marie Cahill
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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27
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Lukies M, Zia A, Kavnoudias H, Bosco JJ, Narita C, Lee R, Joseph T, Clements W. Immune Function After Splenic Artery Embolization for Blunt Trauma: Long-Term Assessment of CD27 + IgM B-Cell Levels. J Vasc Interv Radiol 2022; 33:505-509. [PMID: 35489783 DOI: 10.1016/j.jvir.2022.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/08/2022] [Accepted: 02/02/2022] [Indexed: 12/18/2022] Open
Abstract
Splenic artery embolization (SAE) plays a critical role in the treatment of high-grade splenic injury not requiring emergent laparotomy. SAE preserves splenic tissue, and growing evidence demonstrates preserved short-term splenic immune function after SAE. However, long-term function is less studied. Patients who underwent SAE for blunt abdominal trauma over a 10-year period were contacted for long-term follow-up. Sixteen participants (sex: women, 10, and men, 6; age: median, 34 years, and range, 18-67 years) were followed up at a median of 7.7 years (range, 4.7-12.8 years) after embolization. Splenic lacerations were of American Association for the Surgery of Trauma grades III to V, and 14 procedures involved proximal embolization. All individuals had measurable levels of IgM memory B cells (median, 14.30 as %B cells), splenic tissue present on ultrasound (median, 122 mL), and no history of severe infection since SAE. In conclusion, this study quantitatively demonstrated that long-term immune function remains after SAE for blunt abdominal trauma based on the IgM memory B cell levels.
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Affiliation(s)
- Matthew Lukies
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
| | - Adil Zia
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia; Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Helen Kavnoudias
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
| | - Julian J Bosco
- Department of Respiratory Medicine-Allergy, Asthma and Clinical Immunology, Alfred Health, Melbourne, Victoria, Australia; Central Clinical School, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Callum Narita
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
| | - Robin Lee
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia; Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Timothy Joseph
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
| | - Warren Clements
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia; Department of Surgery, Monash University, Melbourne, Victoria, Australia; National Trauma Research Institute, Melbourne, Victoria, Australia.
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28
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McGraw JR, Cannon JW, Nadolski GJ, Hunt SJ, Clark TW, Gade TP. Pre-Intervention Computed Tomography Improves Performance of Endovascular Intervention in Patients with Abdominopelvic Trauma. J Vasc Interv Radiol 2022; 33:979-986. [DOI: 10.1016/j.jvir.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 04/13/2022] [Accepted: 05/10/2022] [Indexed: 11/16/2022] Open
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Leung-Tack M, Ong EGP, McGuirk S. Interventional radiology and open surgery: An effective partnership for solid organ trauma. J Pediatr Surg 2022; 57:266-270. [PMID: 34838307 DOI: 10.1016/j.jpedsurg.2021.10.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 10/23/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Management algorithms of paediatric blunt abdominal solid organ injury (BASOI) are evolving to include interventional radiology, but there are few studies documenting the application and clinical outcomes of cases in children. METHODS A retrospective case note review of all paediatric BASOI at a single Paediatric Major Trauma Centre was completed. CT scans and injuries have been retrospectively graded according to AAST guidelines. RESULTS In the period February 2012 - October 2019, there were 106 children (median age 10.6 years (range 10 days - 16 years)) with BASOI. Of these, 71% (n = 75) suffered liver injuries, 29% (n = 31) spleen, and 27% (n = 29) renal. 95 children (89.6%) were treated with non-operative management, of which 15% (n = 14) went on to require secondary operative management (surgery, n = 1 & interventional radiology, n = 14). There were no deaths or loss of organ in the group which required secondary operative management, regardless of the grade of injury. CONCLUSION The majority of BASOI can be successfully treated conservatively, but IR is a useful additional tool in management for all grades of injury and is complementary to open surgery. LEVEL OF EVIDENCE Level IV Case Series.
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Affiliation(s)
- Mirana Leung-Tack
- University of Birmingham School of Medicine, Birmingham, United Kingdom
| | - Evelyn Geok Peng Ong
- The Liver Unit, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Steelhouse Lane, Birmingham B4 6NH, United Kingdom.
| | - Simon McGuirk
- Interventional Radiology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
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30
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Tran S, Wilks M, Dawson J. Endovascular Management of Splenic Trauma. SURGERY IN PRACTICE AND SCIENCE 2022. [DOI: 10.1016/j.sipas.2022.100061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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31
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Yokoyama T, Nakahara S, Kondo H, Miyake Y, Sakamoto T. Novel score for predicting early emergency endovascular therapy in trauma care using logistic LASSO regression. Acute Med Surg 2022; 9:e774. [PMID: 35928218 PMCID: PMC9345292 DOI: 10.1002/ams2.774] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 07/11/2022] [Indexed: 11/08/2022] Open
Abstract
Aim To support decision-making for early interventional radiology, this study aimed to derive and validate a novel and simple scoring system for predicting the necessity of interventional radiology therapies in trauma patients. Methods This retrospective study used data derived from the medical records of patients with severe traumatic injuries treated at a tertiary-level emergency institution. The score was derived from 168 patients treated between April 2015 and October 2016 and validated using data from 68 patients treated between November 2016 and July 2017. Logistic "least absolute shrinkage and selection operator (LASSO)" regression was used to select predictors. In order to compose the score, odds ratios derived from the logistic model were simplified to integer score coefficients. The score was evaluated using the area under the receiver operating characteristic curve. The best cut-off point for the score was determined using Youden's index, and sensitivity and specificity were calculated. Results The derived score comprised three predictors (systolic blood pressure, positive findings in abdominal ultrasound assessment, and pelvic fracture) and ranged from 0 to 30. On validation, the area under the receiver operating characteristic curve for the score was 0.86 (95% confidence interval, 0.64-1.00). The sensitivity and specificity were 80% and 89%, respectively, with a cut-off point of 3. Conclusion This simple score, requiring variables obtainable immediately after hospital arrival, could aid in facilitating early interventional radiology team activation.
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Affiliation(s)
- Taro Yokoyama
- Department of Emergency MedicineTeikyo University School of MedicineTokyoJapan
| | - Shinji Nakahara
- Department of Emergency MedicineTeikyo University School of MedicineTokyoJapan
- Graduate School of Health InnovationKanagawa University of Human ServicesKawasakiJapan
| | - Hiroshi Kondo
- Department of RadiologyTeikyo University School of MedicineTokyoJapan
| | - Yasufumi Miyake
- Department of Emergency MedicineTeikyo University School of MedicineTokyoJapan
| | - Tetsuya Sakamoto
- Department of Emergency MedicineTeikyo University School of MedicineTokyoJapan
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32
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Yazdani E, Nasr-Esfahani M, Kolahdouzan M, Pourazari P. Comparing the effectiveness of bupivacaine administration through chest tube and intercostal blockage in patients with rib fractures. Adv Biomed Res 2022; 11:66. [PMID: 36325169 PMCID: PMC9621344 DOI: 10.4103/abr.abr_50_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 08/11/2021] [Accepted: 10/25/2021] [Indexed: 12/02/2022] Open
Abstract
Background: There are several methods to control pain, especially in traumatic patients with rib fractures. Intrapleural analgesia (IPA) and intercostal block methods are recommended in patients with rib fractures to control pain. Here, we aimed to evaluate and compare the effects of IPA and intercostal block on patients’ clinical conditions. Materials and Methods: This is a randomized clinical trial that was performed in 2020–2021 on thirty traumatic patients with rib fractures. We collected the results of arterial blood gas in all patients before interventions including HCO3, pH, pO2, and pCO2 and also evaluated pain of patients. The first group underwent intercostal blockade with standard method with bupivacaine, and for the second group of patients, a chest tube was implanted. Patients were monitored for up to 12 h for pain intensity and need for analgesics. Results: The mean levels of HCO3 decreased in both groups after the interventions, and this decrease was more significant in patients in the intercostal blockade group (P < 0.05). The mean levels of pO2 increased in both groups after interventions, especially in patients in the intercostal blockade group (P < 0.05). The mean pCO2 levels also decreased in both groups (P < 0.05). The mean pain intensity in both groups decreased significantly after the intervention (P < 0.05) and also the mean pain intensity in the intercostal blocking group decreased significantly more than the group treated with chest tube (P < 0.05). Conclusion: Intercostal blockade through bupivacaine is more effective than chest tube administration of bupivacaine in patients with rib fractures.
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Patel NR, Mehdi AS, Sandhu A, Mallon D, Dick E, Batrick N, Kashef E. The value of systematic follow-up imaging for assessing pseudoaneurysm formation after blunt and penetrating liver injury: A level 1 trauma centre experience. TRAUMA-ENGLAND 2021. [DOI: 10.1177/14604086211050188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Hepatic pseudoaneurysm (HPA) is a rare but potentially life-threatening sequelae of blunt or penetrating liver trauma. At our institution, an imaging protocol for liver injury patients has been developed, with repeat computed tomographic (CT) angiography of the liver 48–72 h post-admission to assess for HPA. The purpose of this study was to evaluate the utility of this imaging pathway in liver trauma for the detection of HPAs. Methods A retrospective analysis was performed on patients who were admitted to our institution between January 2014 and January 2018, found to have either blunt or penetrating liver injury on initial CT imaging. Data collection included mechanism of injury, injury severity score (ISS), American Association for the Surgery of Trauma (AAST) liver injury score, initial and follow-up CT findings and secondary intervention. Results During the study period, 149 major trauma patients were admitted with liver injuries (mean age 35.6 years; 72% male, 28% female). Seventy two percent of patients suffered blunt (median ISS = 29; median AAST = 2.89) and 28% patients suffered penetrating injuries (median ISS = 16; median AAST = 2.88). The mean time to follow-up CT was 46.1 h. Follow-up CT identified 8 (5.4%) HPAs. 5 (62.5%) of these patients were treated with embolization. ISS and AAST were not associated with pseudoaneurysm formation according to logistic regression analysis; however, ISS (OR 1.06 [1.02, 1.09; p < 0.05]) and AAST (OR 2.24, [1.31, 3.83; p < 0.05]) were associated with requirement for embolization. Conclusion Our experience indicates a role for early detection of HPAs using a dedicated trauma imaging pathway.
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Affiliation(s)
- Neeral R Patel
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - Aia S Mehdi
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - Amandeep Sandhu
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - Dermot Mallon
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - Elizabeth Dick
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - Nicola Batrick
- Major Trauma Centre, Imperial College Healthcare NHS Trust, London, UK
| | - Elika Kashef
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
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34
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Tran S, Wilks M, Dawson J. Endovascular management of haemorrhage in pelvic trauma. SURGERY IN PRACTICE AND SCIENCE 2021. [DOI: 10.1016/j.sipas.2021.100039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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35
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Weir A, Kennedy P, Joyce S, Ryan D, Spence L, McEntee M, Maher M, O'Connor O. Endovascular management of pelvic trauma. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1196. [PMID: 34430637 PMCID: PMC8350659 DOI: 10.21037/atm-20-4591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 12/18/2020] [Indexed: 11/06/2022]
Abstract
Traumatic pelvic injuries are an important group of acquired pathologies given their frequent association with significant vascular compromise. Potentially fatal as a consequence of rapid hemorrhage, achievement of early hemostasis is a priority; endovascular management of traumatic pelvic arterial injuries is an important potential option for treatment. Precipitated by any number of mechanisms of trauma, pelvic vascular injury necessitates timely patient assessment. Variable patterns of arterial injury may result from blunt, penetrating or iatrogenic trauma. Selection of the most appropriate imaging modality is a priority, ensuring streamlined access to treatment. In the case of CT, this is complemented by acquisition of the most appropriate phase of imaging; review of both arterial and delayed phase imaging improves the accuracy of detection of low-flow hemorrhage. In cases where surgical intervention is not deemed appropriate, endovascular treatment provides an alternative means for cessation of hemorrhage associated with pelvic injuries. This may be achieved in a selective or nonselective manner depending on the patient's clinical status and time constraints. Consequently, a detailed understanding of vascular anatomy is essential, including an appreciation of the normal variant anatomy between males and females. Additional consideration must be given to variant anatomy which may co-exist in both sexes. This review article aims to provide a synopsis of endovascular management of pelvic vascular injury. Through case examples, available treatment options will be discussed, including thrombin injection and transcatheter arterial embolization. Furthermore, potential adverse complications of pelvic arterial embolization will be highlighted. Finally, in view of the potential severity of these injuries, a brief overview of initial management of the hemodynamically unstable patient is provided.
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Affiliation(s)
- Arlene Weir
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland.,Department of Radiology, Mercy University Hospital, Grenville Place, Cork, Ireland
| | - Padraic Kennedy
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland.,Department of Radiology, Mercy University Hospital, Grenville Place, Cork, Ireland
| | - Stella Joyce
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland.,Department of Radiology, Mercy University Hospital, Grenville Place, Cork, Ireland.,School of Medicine, University College Cork, Cork, Ireland
| | - David Ryan
- School of Medicine, University College Cork, Cork, Ireland
| | - Liam Spence
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Mark McEntee
- School of Medicine, University College Cork, Cork, Ireland
| | - Michael Maher
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland.,Department of Radiology, Mercy University Hospital, Grenville Place, Cork, Ireland.,School of Medicine, University College Cork, Cork, Ireland
| | - Owen O'Connor
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland.,Department of Radiology, Mercy University Hospital, Grenville Place, Cork, Ireland.,School of Medicine, University College Cork, Cork, Ireland
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36
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Quencer KB. Endovascular interventions in trauma, an introduction. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1191. [PMID: 34430632 PMCID: PMC8350691 DOI: 10.21037/atm-20-4418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/13/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Keith Bertram Quencer
- Division of Interventional Radiology, Department of Radiology, University of Utah, Salt Lake City, UT, USA
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Khurana A, Quencer K, Saini A, Sill A, Albadawi H, Jamal L, Naidu S, Patel I, Alzubaidi S, Oklu R. Endovascular interventions in the management of acute extremity trauma: a narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1197. [PMID: 34430638 PMCID: PMC8350664 DOI: 10.21037/atm-20-5428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 06/16/2021] [Indexed: 11/06/2022]
Abstract
Minimally invasive endovascular interventions including stenting and embolization have been widely adopted for the treatment of emergent and traumatic thoracoabdominal injuries. In recent years, these techniques have been utilized in the setting of extremity vascular trauma with promising outcomes. By allowing for the rapid diagnosis and subsequent treatment of penetrating or blunt vascular extremity trauma, these techniques can help to minimize blood loss, reduce operative complications, and potentially prevent limb amputation. Here, we present a narrative review of the ever-increasing role of minimally invasive interventions in the management of extremity trauma and compare its use and outcomes to open surgical repair. A special focus is placed on diagnostic imaging modalities in trauma and the role of interventional radiologists in the work-up and treatment of extremity trauma. We discuss diagnostic imaging modalities that aid in the triaging of extremity trauma, such as Doppler sonography, CT angiography, and catheter-based angiography. We present an overview on the literature related to endovascular interventions such as embolotherapy and stent grafting as well as the technical challenges associated with each technique. Finally, we present our own cases on the workup and endovascular treatment of extremity trauma, including CT angiography, particulate and coil embolization, and stent graft placement.
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Affiliation(s)
- Aditya Khurana
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Keith Quencer
- University of Utah, Interventional Radiology, Salt Lake City, Utah, USA
| | - Aman Saini
- Division of Vascular and Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, Scottsdale, AZ, USA
| | - Andrew Sill
- Division of Vascular and Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, Scottsdale, AZ, USA
| | - Hassan Albadawi
- Division of Vascular and Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, Scottsdale, AZ, USA
| | - Leila Jamal
- Division of Vascular and Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, Scottsdale, AZ, USA
| | - Sailendra Naidu
- Division of Vascular and Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, Scottsdale, AZ, USA
| | - Indravadan Patel
- Division of Vascular and Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, Scottsdale, AZ, USA
| | - Sadeer Alzubaidi
- Division of Vascular and Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, Scottsdale, AZ, USA
| | - Rahmi Oklu
- Division of Vascular and Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, Scottsdale, AZ, USA
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Lee CM, Jeon CH, Lee R, Kwon H, Kim CW, Kim JH, Kim JH, Kim H, Kim SH, Lee CK, Park CY, Bae M. Traumatic Hemothorax Caused by Thoracic Wall and Intrathoracic Injuries: Clinical Outcomes of Transcatheter Systemic Artery Embolization. TAEHAN YONGSANG UIHAKHOE CHI 2021; 82:923-935. [PMID: 36238056 PMCID: PMC9514418 DOI: 10.3348/jksr.2020.0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/08/2020] [Accepted: 08/11/2020] [Indexed: 11/15/2022]
Abstract
Purpose We aimed to assess the clinical efficacy of transcatheter arterial embolization (TAE) for treating hemothorax caused by chest trauma. Materials and Methods Between 2015 and 2019, 68 patients (56 male; mean age, 58.2 years) were transferred to our interventional unit for selective TAE to treat thoracic bleeding. We retrospectively investigated their demographics, angiographic findings, embolization techniques, technical and clinical success rates, and complications. Results Bleeding occurred mostly from the intercostal arteries (50%) and the internal mammary arteries (29.5%). Except one patient, TAE achieved technical success, defined as the immediate cessation of bleeding, in all the other patients. Four patients successfully underwent repeated TAE for delayed bleeding or increasing hematoma after the initial TAE. The clinical success rate, defined as no need for thoracotomy for hemostasis after TAE, was 92.6%. Five patients underwent post-embolization thoracotomy for hemostasis. No patient developed major TAE-related complications, such as cerebral infarction or quadriplegia. Conclusion TAE is a safe, effective and minimally invasive method for controlling thoracic wall and intrathoracic systemic arterial hemorrhage after thoracic trauma. TAE may be considered for patients with hemothorax without other concomitant injuries which require emergency surgery, or those who undergoing emergency TAE for abdominal or pelvic hemostasis.
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Roberts R, Sheth RA. Hepatic trauma. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1195. [PMID: 34430636 PMCID: PMC8350720 DOI: 10.21037/atm-20-4580] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 01/25/2021] [Indexed: 12/13/2022]
Abstract
Management of trauma-related liver injury has undergone a paradigm shift over the past four decades. In hemodynamically stable patients, the standard of care in the majority of level-one trauma centers has shifted to nonoperative management with high success rates, especially with low-grade liver injuries (i.e., grade I and II liver injuries). Advances in critical care medicine, cross-sectional imaging, and transarterial embolization techniques have led to the improvement of patient outcomes and decreased mortality rates in patients with arterial injuries. Currently, no consensus guidelines on appropriate patient selection criteria have been published by the Society of Interventional Radiology (SIR) or the American Association for the surgery of Trauma (AAST). Based off the current literature, nonoperative management with hepatic angiography and transarterial embolization (TAE) should be the treatment of choice in hemodynamically stable patients with clinical suspicion of arterial injury. TAE has been shown to improve success rates of nonoperative management and is well tolerated by most patients with low complication rates. Hepatic necrosis is the most common and concerning reported complication but can be reduced with selective approach and choice of embolic agent. The majority of literature supporting the use of TAE for trauma-related liver injury consists of retrospective case series and additional larger scale studies are needed to determine the efficacy of TAE in this setting. However, it is clear from the current literature that hepatic TAE is an effective and safer option to operative management in treating arterial hemorrhage in the setting of traumatic hepatic injury.
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Affiliation(s)
- Rene Roberts
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Rahul A. Sheth
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Gasparetto A, Hunter D, Sapoval M, Sharma S, Golzarian J. Splenic embolization in trauma: results of a survey from an international cohort. Emerg Radiol 2021; 28:955-963. [PMID: 34115235 DOI: 10.1007/s10140-021-01929-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 03/24/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE A questionnaire regarding splenic embolization in trauma was submitted to an international sample of IR faculty members, to compare their practice to the available recommendations. METHODS A 21 multiple-choice questionnaire was sent to an international cohort of 96 IR faculty. Questions included the initial patient evaluation, embolization materials and techniques, post-procedure management, availability of an institutional protocol, and use of guidelines. RESULTS For each question, there were from a minimum of 45 to a maximum of 52 responders: 94% require a CT with contrast prior to embolization, and 87% use the American Association for the Surgery of Trauma (AAST) scale to grade the splenic injuries. Embolization is performed across all values of the AAST scale. Of the patients with injuries of grade III or greater, embolization is primarily done for those patients who are hemodynamically stable. Unstable patients are embolized less frequently and primarily in cases in which the injuries are of a lower grade. Coils are the preferred material for proximal embolization (69%). Particles/Gelfoam is the preferred material for distal embolization (38%). In total, 63% administer intravenous antibiotics before the procedure and 15% administer intra-arterial antibiotics during the procedure. After embolization, follow-up imaging is recommended by 87%, antibiotics are administered regularly by 33%, clinical follow-up is recommended by 73%, and vaccination against encapsulated organisms is routinely recommended by 39%. CONCLUSIONS There is significant variability among a heterogeneous cohort of respondents. Available recommendations may not be sufficiently addressing the practice of splenic embolization.
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Affiliation(s)
| | - David Hunter
- University of Minnesota, 420 Delaware Street SE, Minneapolis, MN, 55455, USA
| | - Marc Sapoval
- Hopital Europeen Georges-Pompidou (Hopitaux Universitaires Paris-Ouest), 20 Rue Leblanc 75015, Paris, France
| | - Sandeep Sharma
- University of Minnesota, 420 Delaware Street SE, Minneapolis, MN, 55455, USA
| | - Jafar Golzarian
- University of Minnesota, 420 Delaware Street SE, Minneapolis, MN, 55455, USA
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Abstract
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.
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Affiliation(s)
- Akshita S Pillai
- School of Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Girish Kumar
- Division of Interventional Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Anil K Pillai
- Division of Interventional Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
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Pillai AS, Srinivas S, Kumar G, Pillai AK. Where Does Interventional Radiology Fit in with Trauma Management Algorithm? Semin Intervent Radiol 2021; 38:3-8. [PMID: 33883796 DOI: 10.1055/s-0041-1725114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Trauma is a major cause of death in the United States, particularly in the younger population. Many traumatic deaths, as well as major morbidity, occur secondary to uncontrolled hemorrhage and eventual exsanguination. Interventional radiology plays a major role in treating these patients, and interventional techniques have evolved to the point where they are an integral part of treatment in these critically ill patients. This article reviews the role of interventional radiology in the treatment algorithms for traumatic injury sponsored by major societies and associations.
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Affiliation(s)
- A S Pillai
- University of Texas, Medical Branch Galveston, Galveston, Texas
| | - S Srinivas
- University of Texas, Medical Branch Galveston, Galveston, Texas
| | - G Kumar
- Southwestern Medical Center, University of Texas, Dallas, Texas
| | - A K Pillai
- Southwestern Medical Center, University of Texas, Dallas, Texas
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Weaver JJ, Chick JFB, Monroe EJ, Johnson GE. Life and Limb: Current Concepts in Endovascular Treatment of Extremity Trauma. Semin Intervent Radiol 2021; 38:64-74. [PMID: 33883803 DOI: 10.1055/s-0041-1724011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Traumatic injury is the leading cause of death worldwide in younger patient populations and extremity trauma with associated vascular injury accounts for many trauma-related deaths. Iatrogenic injury is also a common cause of extremity vascular trauma and the incidence of iatrogenic injury will likely increase as endovascular techniques continue to become more ubiquitous. For many vascular injuries involving the extremities, surgical repair is viewed as the standard of care. Historically, endovascular techniques did not play a role in the treatment of these vascular injuries, rather they were utilized only as part of the diagnostic assessment; however, there is an increasing trend toward endovascular management of extremity vascular trauma. No validated, widely implemented algorithm to select patients for endovascular intervention exists. Transcatheter techniques, however, play an important role in the management of these patients. For arterial injuries, embolization can be used to rapidly achieve hemostasis if the vessel can be sacrificed. More advanced endovascular techniques such as stent-graft placement may be best employed in the context of isolated, proximal extremity injuries, although there is increasing literature supporting the use of advanced techniques for more distal arterial injuries. The management of peripheral venous trauma remains controversial; however, there is growing data describing successful endovascular management of some peripheral venous injuries. The purpose of this article is to review extremity vascular trauma, concepts of injury triage, endovascular techniques, and intraprocedural considerations.
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Affiliation(s)
- John J Weaver
- Division of Interventional Radiology, Department of Radiology, University of Washington, Seattle, Washington
| | - Jeffrey F B Chick
- Division of Interventional Radiology, Department of Radiology, University of Washington, Seattle, Washington
| | - Eric J Monroe
- Division of Interventional Radiology, Department of Radiology, University of Washington, Seattle, Washington.,Division of Interventional Radiology, Department of Radiology, Seattle Children's Hospital, Seattle, Washington
| | - Guy E Johnson
- Division of Interventional Radiology, Department of Radiology, University of Washington, Seattle, Washington
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Abstract
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.
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Affiliation(s)
- Jorge E Lopera
- Department of Radiology, UT Health San Antonio, San Antonio, Texas
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Kord A, Kuwahara JT, Rabiee B, Ray CE. Basic Principles of Trauma Embolization. Semin Intervent Radiol 2021; 38:144-152. [PMID: 33883812 DOI: 10.1055/s-0041-1726004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Ali Kord
- Division of Interventional Radiology, Department of Radiology, University of Illinois College of Medicine, Chicago, Illinois
| | - Jeffery T Kuwahara
- Division of Interventional Radiology, Department of Radiology, University of Illinois College of Medicine, Chicago, Illinois
| | - Behnam Rabiee
- Division of Interventional Radiology, Department of Radiology, University of Illinois College of Medicine, Chicago, Illinois
| | - Charles E Ray
- Division of Interventional Radiology, Department of Radiology, University of Illinois College of Medicine, Chicago, Illinois
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Luckhurst CM, Mendoza AE. The Current Role of Interventional Radiology in the Management of Acute Trauma Patient. Semin Intervent Radiol 2021; 38:34-39. [PMID: 33883799 PMCID: PMC8049765 DOI: 10.1055/s-0041-1725113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Trauma is one of the most common causes of death, particularly in younger individuals. The development of specialized trauma centers, trauma-specific intensive care units, and trauma-focused medical subspecialties has led to the formation of comprehensive multidisciplinary teams and an ever-growing body of research and innovation. The field of interventional radiology provides a unique set of minimally invasive, endovascular techniques that has largely changed the way that many trauma patients are managed. This article discusses the role of interventional radiology in the care of this complex patient population, and in particular how the specialty fits into the overall team management of these patients.
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Affiliation(s)
- Casey M. Luckhurst
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - April E. Mendoza
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
- Department of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts
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Clinical and laboratory parameters in blunt pelvic trauma not associated with subsequent positive conventional angiography in patients with positive CTA. Emerg Radiol 2021; 28:557-563. [PMID: 33428045 DOI: 10.1007/s10140-020-01888-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/14/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE This study evaluates clinical and laboratory parameters, as well as extravasation and hematoma size on CTA as potential predictors of conventional angiogram (CA) results. METHODS This is a retrospective study of 380 adult patients presenting with pelvic trauma over a 9-year period. Of these patients, 91 were found to have active arterial extravasation on initial CTA. Statistical analysis between the two groups +CA versus -CA was performed to determine whether clinical and laboratory parameters, as well as extravasation size and hematoma size could predict CA results. RESULTS There were no significant differences in all clinical and laboratory data, including hemodynamic instability (defined as systolic blood pressure < 90 mmHg) on presentation (22.2% vs. 21.4%), except for Glasgow Coma Scale (p = 0.015) when comparing the two groups. Extravasation size and hematoma size as continuous or categorical variables were not predictive of subsequent positive CA. Secondary analysis demonstrated no association between select parameters (i.e., hematocrit, systolic blood pressure, and lactate) and subsequent positive CA while controlling for extravasation size or hematoma size. CONCLUSION Clinical and laboratory parameters in blunt pelvic trauma with arterial hemorrhage were not significantly associated with subsequent conventional angiography results, once accounting for degree of hemorrhage. The area of the foci of active extravasation and hematoma size in the axial plane were not significantly associated with the need for embolization. We conclude from these findings that catheter angiography should be considered in patients with blunt pelvic trauma found to have active arterial extravasation, regardless of size of bleed or the patient's clinical or laboratory values.
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Spiliopoulos S, Katsanos K, Paraskevopoulos I, Mariappan M, Festas G, Kitrou P, Papageorgiou C, Reppas L, Palialexis K, Karnabatidis D, Brountzos E. Multicenter retrospective study of transcatheter arterial embolisation for life-threatening haemorrhage in patients with uncorrected bleeding diathesis. CVIR Endovasc 2020; 3:95. [PMID: 33301058 PMCID: PMC7728894 DOI: 10.1186/s42155-020-00186-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/29/2020] [Indexed: 02/08/2023] Open
Abstract
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.
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Affiliation(s)
- Stavros Spiliopoulos
- grid.5216.00000 0001 2155 08002nd Department of Radiology, Interventional Radiology Unit, Medical School, National and Kapodistrian University of Athens, “Attikon” University Hospital, Athens, Greece
- grid.417581.e0000 0000 8678 4766Department of Clinical Radiology, Interventional Radiology Unit, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, AB25 2ZN UK
| | - Konstantinos Katsanos
- grid.412458.eDepartment of Interventional Radiology, School of Medicine, Patras University Hospital, Rion, Greece
| | - Ioannis Paraskevopoulos
- grid.417581.e0000 0000 8678 4766Department of Clinical Radiology, Interventional Radiology Unit, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, AB25 2ZN UK
| | - Martin Mariappan
- grid.417581.e0000 0000 8678 4766Department of Clinical Radiology, Interventional Radiology Unit, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, AB25 2ZN UK
| | - Georgios Festas
- grid.5216.00000 0001 2155 08002nd Department of Radiology, Interventional Radiology Unit, Medical School, National and Kapodistrian University of Athens, “Attikon” University Hospital, Athens, Greece
| | - Panagiotis Kitrou
- grid.412458.eDepartment of Interventional Radiology, School of Medicine, Patras University Hospital, Rion, Greece
| | - Christos Papageorgiou
- grid.412458.eDepartment of Interventional Radiology, School of Medicine, Patras University Hospital, Rion, Greece
| | - Lazaros Reppas
- grid.5216.00000 0001 2155 08002nd Department of Radiology, Interventional Radiology Unit, Medical School, National and Kapodistrian University of Athens, “Attikon” University Hospital, Athens, Greece
| | - Konstantinos Palialexis
- grid.5216.00000 0001 2155 08002nd Department of Radiology, Interventional Radiology Unit, Medical School, National and Kapodistrian University of Athens, “Attikon” University Hospital, Athens, Greece
| | - Dimitrios Karnabatidis
- grid.412458.eDepartment of Interventional Radiology, School of Medicine, Patras University Hospital, Rion, Greece
| | - Elias Brountzos
- grid.5216.00000 0001 2155 08002nd Department of Radiology, Interventional Radiology Unit, Medical School, National and Kapodistrian University of Athens, “Attikon” University Hospital, Athens, Greece
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