Semin intervent Radiol 2010; 27(1): 014-028
DOI: 10.1055/s-0030-1247885
© Thieme Medical Publishers

Embolization in Trauma: Principles and Techniques

Jorge E. Lopera1
  • 1Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
Further Information

Publication History

Publication Date:
13 March 2010 (online)

ABSTRACT

Trauma continues to be the leading cause of death in the young population. Uncontrolled bleeding is a major factor in early mortality after trauma, contributing to 30 to 40% of trauma-related deaths. Transcatheter embolization techniques play a significant role in the comprehensive modern treatment of traumatic vascular injuries to solid organs and extremities. The purpose of this article is to review current principles and techniques in the use of embolization for the treatment of traumatic arterial injuries of solid organs and extremities.

REFERENCES

  • 1 Bauer J R, Ray C E. Transcatheter arterial embolization in the trauma patient: a review.  Semin Intervent Radiol. 2004;  21 11-22
  • 2 Spahn D R, Cerny V, Coats T J Task Force for Advanced Bleeding Care in Trauma et al. Management of bleeding following major trauma: a European guideline.  Crit Care. 2007;  11 R17
  • 3 Frevert S, Dahl B, Lönn L. Update on the roles of angiography and embolisation in pelvic fracture.  Injury. 2008;  39 1290-1294
  • 4 Doody O, Given M F, Lyon S M. Extremities—indications and techniques for treatment of extremity vascular injuries.  Injury. 2008;  39 1295-1303
  • 5 Vaidya A, Tozer K R, Chen J. An overview of embolic agents.  Semin Intervent Radiol. 2008;  25 204-215
  • 6 Abada H T, Golzarian J. Gelatine sponge particles: handling characteristics for endovascular use.  Tech Vasc Interv Radiol. 2007;  10 257-260
  • 7 Barth K H, Strandberg J D, White R L. Long term follow-up of transcatheter embolization with autologous clot, oxycel and gelfoam in domestic swine.  Invest Radiol. 1977;  12 273-280
  • 8 Laurent A. Microspheres and nonspherical particles for embolization.  Tech Vasc Interv Radiol. 2007;  10 248-256
  • 9 Jander H P, Russinovich N A. Transcatheter gelfoam embolization in abdominal, retroperitoneal, and pelvic hemorrhage.  Radiology. 1980;  136 337-344
  • 10 Katsumori T, Kasahara T. The size of gelatin sponge particles: differences with preparation method.  Cardiovasc Intervent Radiol. 2006;  29 1077-1083
  • 11 Laurent A, Wassef M, Saint Maurice J P et al.. Arterial distribution of calibrated tris-acryl gelatin and polyvinyl alcohol microspheres in a sheep kidney model.  Invest Radiol. 2006;  41 8-14
  • 12 Mavili E, Donmez H, Ozcan N, Akcali Y. Endovascular treatment of lower limb penetrating arterial traumas.  Cardiovasc Intervent Radiol. 2007;  30 1124-1129
  • 13 Widlus D M, Moeslein F M, Richard III H M. Evaluation of the Amplatzer vascular plug for proximal splenic artery embolization.  J Vasc Interv Radiol. 2008;  19 652-656
  • 14 Piffaretti G, Tozzi M, Lomazzi C et al.. Endovascular treatment for traumatic injuries of the peripheral arteries following blunt trauma.  Injury. 2007;  38 1091-1097
  • 15 Burdick T R, Hoffer E K, Kooy T et al.. Which arteries are expendable? The practice and pitfalls of embolization throughout the body.  Semin Intervent Radiol. 2008;  25 191-203
  • 16 Parodi J C, Schönholz C, Ferreira L M, Bergan J. Endovascular stent-graft treatment of traumatic arterial lesions.  Ann Vasc Surg. 1999;  13 121-129
  • 17 Scalea T M, Sclafani S J. Angiographically placed balloons for arterial control: a description of a technique.  J Trauma. 1991;  31 1671-1677
  • 18 Lopera J E, Suri R, Cura M, Kroma G, El-Merhi F. Crural artery traumatic injuries: treatment with embolization.  Cardiovasc Intervent Radiol. 2008;  31 550-557
  • 19 Monnin V, Sengel C, Thony F et al.. Place of arterial embolization in severe blunt hepatic trauma: a multidisciplinary approach.  Cardiovasc Intervent Radiol. 2008;  31 875-882
  • 20 Mohr A M, Lavery R F, Barone A et al.. Angiographic embolization for liver injuries: low mortality, high morbidity.  J Trauma. 2003;  55 1077-1081 discussion 1081-1082
  • 21 Dabbs D N, Stein D M, Scalea T M. Major hepatic necrosis: a common complication after angioembolization for treatment of high-grade liver injuries.  J Trauma. 2009;  66 621-627 discussion 627-629
  • 22 Bessoud B, Denys A, Calmes J M et al.. Nonoperative management of traumatic splenic injuries: is there a role for proximal splenic artery embolization?.  AJR Am J Roentgenol. 2006;  186 779-785
  • 23 Raikhlin A, Baerlocher M O, Asch M R, Myers A. Imaging and transcatheter arterial embolization for traumatic splenic injuries: review of the literature.  Can J Surg. 2008;  51 464-472
  • 24 Wu S C, Chen R J, Yang A D, Tung C C, Lee K H. Complications associated with embolization in the treatment of blunt splenic injury.  World J Surg. 2008;  32 476-482
  • 25 Hamers R L, Van Den Berg F G, Groeneveld A B. Acute necrotizing pancreatitis following inadvertent extensive splenic artery embolization for trauma.  Br J Radiol. 2009;  82 e11-e14
  • 26 Brewer Jr M E, Strnad B T, Daley B J et al.. Percutaneous embolization for the management of grade 5 renal trauma in hemodynamically unstable patients: initial experience.  J Urol. 2009;  181 1737-1741
  • 27 Breyer B N, McAninch J W, Elliott S P, Master V A. Minimally invasive endovascular techniques to treat acute renal hemorrhage.  J Urol. 2008;  179 2248-2252 discussion 2253
  • 28 Verbeek D, Sugrue M, Balogh Z et al.. Acute management of hemodynamically unstable pelvic trauma patients: time for a change? Multicenter review of recent practice.  World J Surg. 2008;  32 1874-1882
  • 29 Demetriades D, Karaiskakis M, Toutouzas K, Alo K, Velmahos G, Chan L. Pelvic fractures: epidemiology and predictors of associated abdominal injuries and outcomes.  J Am Coll Surg. 2002;  195 1-10
  • 30 Agolini S F, Shah K, Jaffe J, Newcomb J, Rhodes M, Reed III J F. Arterial embolization is a rapid and effective technique for controlling pelvic fracture hemorrhage.  J Trauma. 1997;  43 395-399
  • 31 Hare W S, Holland C J. Paresis following internal iliac artery embolization.  Radiology. 1983;  146 47-51

Jorge E LoperaM.D. F.S.I.R. 

Professor of Radiology, Department of Radiology

7703 Floyd Curl Drive, San Antonio, TX 78229

Email: Lopera@uthscsa.edu

    >