ABSTRACT
Since the development of angiography and transcatheter techniques, interventional
radiology has played an important role in the management of trauma patients. The ability
to treat life-threatening hemorrhage with transcatheter embolization has spared countless
patients the morbidity of surgery. Advances in cross-sectional imaging and increases
in understanding of which patients will best benefit from embolization promise to
further refine the interventional radiologist's role. As the applications of transcatheter
therapy broaden to include embolization of unstable patients with solid organ injuries
and endovascular repair of major arterial injuries, the interventional radiologist
must be increasingly prepared to provide prompt, efficient, and high-quality service.
KEYWORDS
Trauma - angiography - embolization
REFERENCES
- 1
McGahan J P, Wang L, Richards J R.
Focused abdominal US for trauma.
Radiographics.
2001;
21
S191-S199
- 2
Yao D C, Jeffrey R B, Mirvis S E et al..
Using contrast-enhanced helical CT to visualize arterial extravasation after blunt
abdominal trauma: incidence and organ distribution.
AJR Am J Roentgenol.
2002;
178
17-20
- 3
Haan J, Scott J, Boyd-Kranis R L, Ho S, Kramer M, Scalea T M.
Admission angiography for blunt splenic injury: advantages and pitfalls.
J Trauma.
2001;
51
1161-1165
- 4
Sclafani S J, Shaftan G W, Scalea T M et al..
Nonoperative salvage of computed tomography-diagnosed splenic injuries: utilization
of angiography for triage and embolization for hemostasis.
J Trauma.
1995;
39
818-827
- 5
Dent D, Alsabrook G, Erickson B A et al..
Blunt splenic injuries: high nonoperative management rate can be achieved with selective
embolization.
J Trauma.
2004;
56
1063-1067
- 6
Omert L A, Salyer D, Dunham M, Porter J, Silva A, Protetch J.
Implications of the “contrast blush” finding on computed tomographic scan of the spleen
in trauma.
J Trauma.
2001;
51
272-278
- 7
Cox C S, Geiger J D, Liu D C, Garver K.
Pediatric blunt abdominal trauma: role of computed tomography vascular blush.
J Pediatr Surg.
1997;
32
1196-1200
- 8
Schurr M J, Fabian T C, Gavant M et al..
Management of blunt splenic trauma: computed tomographic contrast blush predicts failure
of nonoperative management.
J Trauma.
1995;
39
507-513
- 9
Bessoud B, Denys A, Calmes J M et al..
Non-operative management of traumatic splenic injuries: is there a role for proximal
splenic artery embolization?.
AJR Am J Roentgenol.
2006;
186
779-785
- 10
Haan J M, Bochicchio G V, Kramer N, Scalea T M.
Nonoperative management of blunt splenic injury: a 5-year experience.
J Trauma.
2005;
58
492-498
- 11
Killeen K L, Shanmuganathan K, Boyd-Kranis R, Scalea T M, Mirvis S E.
CT findings after embolization for blunt splenic trauma.
J Vasc Interv Radiol.
2001;
12
209-214
- 12
Wahl W L, Ahrns K S, Chen S, Hemmila M R, Rowe S A, Arbabi S.
Blunt splenic injury: operation versus angiographic embolization.
Surgery.
2004;
136
891-899
- 13
Schwartz R A, Teitelbaum G P, Katz M D, Pentecost M J.
Effectiveness of transcatheter embolization in the control of hepatic vascular injuries.
J Vasc Interv Radiol.
1993;
4
359-365
- 14
Poletti P A, Mirvis S E, Shanmuganathan K, Killeen K L, Coldwell D.
CT criteria for management of blunt liver trauma: correlation with angiographic and
surgical findings.
Radiology.
2000;
216
418-427
- 15
Pachter H L, Knudson M M, Esrig B et al..
Status of nonoperative management of blunt hepatic injuries in 1995: a multicenter
experience with 404 patients.
J Trauma.
1996;
40
31-38
- 16
Santucci R A, Wessells H, Bartsch G et al..
Consensus on genitourinary trauma. Evaluation and management of renal injuries: consensus
statement of the renal trauma subcommittee.
BJU Int.
2004;
93
937-954
- 17
Hagiwara A, Sakaki S, Goto H et al..
The role of interventional radiology in the management of blunt renal injury: a practical
protocol.
J Trauma.
2001;
51
526-531
- 18
Richman S D, Green W M, Kroll R, Casarella W J.
Superselective transcatheter embolization of traumatic renal hemorrhage.
AJR Am J Roentgenol.
1977;
128
843-844
- 19
Wintermark M, Wicky S, Schnyder P.
Imaging of acute traumatic injuries of the thoracic aorta.
Eur Radiol.
2002;
12
431-442
- 20
Richardson P, Mirvis S E, Scorpio R, Dunham C M.
Value of CT in determining the need for angiography when findings of mediastinal hemorrhage
on chest radiographs are equivocal.
AJR Am J Roentgenol.
1991;
156
273-279
- 21
Cohen A M, Crass J R.
Traumatic lacerations of the aorta and great vessels with a normal mediastinum at
radiography.
J Vasc Interv Radiol.
1992;
3
541-544
- 22
Alkadhi H, Wildermuth S, Desbiolles L et al..
Vascular emergencies of the thorax after blunt and iatrogenic trauma: multi-detector
row CT and three-dimensional imaging.
Radiographics.
2004;
24
1239-1255
- 23
Homma H, Yukioka T, Ishimaru S et al..
Two-year follow-up after multiple injuries treated with endovascular stent-grafting
of aorta and transcatheter arterial embolization of spleen: minimal invasive surgery
for an elderly patient.
J Trauma.
2002;
52
382-386
- 24
Yoon W, Kim J K, Jeong Y Y, Seo J J, Park J G, Kang H K.
Pelvic arterial hemorrhage in patients with pelvic fractures: detection with contrast-enhanced
CT.
Radiographics.
2004;
24
1591-1606
- 25
Agolini S F, Shah K, Jaffe J, Newcomb J, Rhodes M, Reed J F.
Arterial embolization is a rapid and effective technique for controlling pelvic fracture
hemorrhage.
J Trauma.
1997;
43
395-399
- 26
Eastridge B J, Starr A, Minei J P, O'Keefe G E.
The importance of fracture pattern in guiding therapeutic decision-making in patients
with hemorrhage shock and pelvic ring disruptions.
J Trauma.
2002;
53
446-451
- 27
Hak D J.
The role of pelvic angiography in evaluation and management of pelvic trauma.
Orthop Clin North Am.
2004;
35
439-443
- 28
Ghanayem A J, Wilber J H, Lieberman J M, Motta A O.
The effect of laparotomy and external fixator stabilization on pelvic volume in an
unstable pelvic injury.
J Trauma.
1995;
38
396-400
- 29
Hagiwara A, Minakawa K, Fukushima H, Murata A, Masuda H, Shimazaki S.
Predictors of death in patients with life-threatening pelvic hemorrhage after successful
transcatheter arterial embolization.
J Trauma.
2003;
55
696-703
- 30
Grimm M R, Vrahas M S, Thomas K A.
Pressure-volume characteristics of the intact and disrupted pelvic retroperitoneum.
J Trauma.
1998;
44
454-459
- 31
Miller P R, Moore P S, Mansell E, Meredith J W, Chang M C.
External fixation or arteriogram in bleeding pelvic fracture: initial therapy guided
by markers of arterial hemorrhage.
J Trauma.
2003;
54
437-443
- 32
Coldwell D M.
Interventional radiology in the management of pelvic fractures.
Semin Intervent Radiol.
2003;
20
89-95
- 33
Ramirez J, Velmajos G C, Best C R, Chan L S, Demetriades D.
Male sexual function after bilateral internal iliac artery embolization for pelvic
fracture.
J Trauma.
2004;
56
734-741
- 34
Yasumura K, Ikegami K, Kamohara T, Nohara Y.
High incidence of ischemic necrosis of the gluteal muscle after transcatheter angiographic
embolization for severe pelvic fracture.
J Trauma.
2005;
58
985-990
- 35
Miller-Thomas M M, West O C, Cohen A M.
Diagnosing traumatic arterial injury in the extremities with CT angiography: pearls
and pitfalls.
Radiographics.
2005;
25
S133-S142
- 36
Abou-Sayed H, Berger D L.
Blunt lower-extremity trauma and popliteal artery injuries.
Arch Surg.
2002;
137
585-589
- 37
Dennis J W, Frykberg E R, Veldenz H C, Huffman S, Menawat S S.
Validation of nonoperative management of occult vascular injuries and accuracy of
physical examination alone in penetrating extremity trauma: 5- to 10-year follow-up.
J Trauma.
1998;
44
243-253
- 38
McCorkell S J, Harley J D, Morishima M S, Cummings D K.
Indications for angiography in extremity trauma.
AJR Am J Roentgenol.
1985;
145
1245-1247
- 39
Kaufman J A, Parker J E, Gillespie D L, Greenfield A J, Woodson J, Menzoian J O.
Arteriography for proximity of injury in penetrating extremity trauma.
J Vasc Interv Radiol.
1992;
3
719-723
- 40
Conrad M F, Patton J H, Parikshak M, Kralovich K A.
Evaluation of vascular injury in penetrating extremity trauma: angiographers stay
home.
Am Surg.
2002;
68
269-274
- 41
Nicholson A A.
Vascular radiology in trauma.
Cardiovasc Intervent Radiol.
2004;
27
105-120
- 42
Maynar M, Baro M, Qian Z et al..
Endovascular repair of brachial artery transaction associated with trauma.
J Trauma.
2004;
56
1336-1341
- 43
Brandt M M, Kazanjian S, Wahl W L.
The utility of endovascular stents in the treatment of blunt arterial injuries.
J Trauma.
2001;
51
901-905
- 44
Pfammatter T, Kunzli A, Hilfiker P R, Schubiger C, Marko T.
Relief of subclavian venous and brachial plexus compression syndrome caused by traumatic
subclavian artery aneurysm by means of transluminal stent-grafting.
J Trauma.
1998;
45
972-974
- 45
Althaus S J, Keskey T S, Harker C P, Coldwell D M.
Percutaneous placement of self-expanding stent for acute traumatic arterial injury.
J Trauma.
1996;
41
145-148
- 46
Lyden S P, Srivastava S D, Waldman D L, Green R M.
Common iliac artery dissection after blunt trauma: case report of endovascular repair
and literature review.
J Trauma.
2001;
50
339-342
- 47
Rieger M, Mallouhi A, Tauscher T, Lutz M, Jaschke W R.
Traumatic arterial injuries of the extremities: initial evaluation with MDCT angiography.
AJR Am J Roentgenol.
2006;
186
656-664
Jennifer E GouldM.D.
Assistant Professor, Radiology, Interventional Radiology, Mallinckrodt Institute of
Radiology
510 S. Kingshighway Blvd., St. Louis, MO 63110
