Transcatheter Arterial Embolization in the Trauma Patient: A Review

Blunt and penetrating traumatic injuries may result in acute or subacute vascular injuries. These injuries to solid organs and extremity vessels are often managed in a conservative fashion. Acuity and hemodynamic compromise may dictate a surgical course; however, interventional techniques first popularized in the early 1970s now offer a wide range of solutions principally using transcatheter arterial embolization. There are a wide range of materials and clinical scenarios for which embolization is appropriate. Embolic agents such as coils, Gelfoam, and particles may be used individually or in combination to stop or control bleeding. In this way, embolotherapy may prove to be the safest and most effective form of therapy. The purpose of this article is to review the indications for embolization in the trauma patient and to provide guidelines regarding techniques and material selection.

KEYWORDS

Embolization - trauma - transcatheter arterial embolization

REFERENCES

• 1 Rich N M, Baugh J H, Hughes C W. Acute arterial injuries in Vietnam: 1,000 cases.  J Trauma. 1970;  10 359-369
• 2 DeBakey M E, Simeone F A. Battle injuries of the arteries in World War II: an analysis of 2,471 cases.  Ann Surg. 1946;  123 534-573
• 3 Inui F K, Shannon J, Howard J M. Arterial injuries in the Korean conflict: experiences with 111 consecutive cases.  Ann Surg. 1954;  17 850-857
• 4 Rosch J, Dotter C T, Brown M J. Selective arterial embolization: a new method for control of acute gastrointestinal bleeding.  Radiology. 1972;  102 303-306
• 5 Bookstein J J, Goldstein H M. Successful management of postbiopsy arteriovenous fistula with selective arterial embolization.  Radiology. 1973;  109 535-536
• 6 Fisher R G, Ben-Menachem Y, Whigham C. Stab wounds of the renal artery branches: angiographic diagnosis and treatment by embolization.  AJR Am J Roentgenol. 1989;  152 1231-1235
• 7 Dinkel H, Danuser H, Triller J. Blunt renal trauma: minimally invasive management with microcatheter embolization-experience with nine patients.  Radiology. 2002;  223 723-730
• 8 Sclafani S JA, 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;  39 818-825
• 9 Hagiwara A, Ukioka T, Ohta S et al.. Nonsurgical management of patients with blunt splenic injury: efficacy of transcatheter arterial embolization.  AJR Am J Roentgenol. 1996;  167 159-166
• 10 Velmahos G C, Chahwan S, Falabella A, Hanks S E, Demetriades D. Angiographic embolization for intraperitoneal and retroperitoneal injuries.  World J Surg. 2000;  24 539-545
• 11 Kaufman S L, Martin L G, Zuckerman A M et al.. Peripheral transcatheter embolization with platinum microcoils.  Radiology. 1992;  184 369-372
• 12 Scalfani J A, Cooper R, Shaftan G W et al.. Arterial trauma: diagnostic and therapeutic angiography.  Radiology. 1986;  161 165-172
• 13 Rose S C, Moore E E. Emergency trauma angiography: accuracy, safety and pitfalls.  AJR Am J Roentgenol. 1987;  148 1243-1246
• 14 Vassiliu P, Sava J, Toutouzas K G, Velmahos G C. Is contrast as bad as we think? Renal function after angiographic embolization of injured patients.  J Am Coll Surg. 2002;  194 142-146
• 15 Ray C E, Waltman A C. General principles of embolization and chemoembolization. In: Vascular and Interventional Radiology: Principles and Practice, 1st ed New York; Thieme 2002: 89-100
• 16 Coldwell D M, Stokes K R, Yakes W F. Embolotherapy: agents, clinical applications, and techniques.  Radiographics. 1994;  14 623-643
• 17 Hanks S E, Pentecost M J. Angiography and transcatheter treatment of extremity trauma.  Semin Interv Radiol. 1992;  9 19-27
• 18 Jackson J E, Mitchell A. Advanced vascular interventional techniques in the management of trauma.  Semin Interv Radiol. 1997;  14 139-150
• 19 Davis K A, Fabian T C, Croce M A et al.. Improved success in nonoperative management of blunt splenic injuries: embolization of splenic artery pseudoaneurysms.  J Trauma. 1998;  44 1008-1013
• 20 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
• 21 Larsen D W, Pentecost M J. Embolotherapy in renal trauma.  Semin Interv Radiol. 1992;  9 13-18
• 22 Altman A L, Haas C, Dinchaman K H, Spirnak J P. Selective nonoperative management of blunt grade 5 renal injury.  J Urol. 2000;  164 27-31
• 23 Ray C E. Renal embolization.  Semin Interv Radiol. 2001;  18 37-45
• 24 Heyns C F, Van Vollenhoven P. Increasing role of angiography and segmental artery embolization in the management of renal stab wounds.  J Urol. 1992;  147 1231-1234
• 25 Corr P, Hacking G. Embolization in traumatic intrarenal vascular injuries.  Clin Radiol. 1991;  43 262-264
• 26 Wahl W L, Ahrns K S, Brandt M, Franklin G A, Taheri P A. The need for early angiographic embolization in blunt liver injuries.  J Trauma. 2002;  52 1097-1101
• 27 Brasel K J, DeLisle C M, Olson C J, Borgstrom D C. Splenic injury: trends in evaluation and management.  J Trauma. 1998;  44 283-286
• 28 Shanmuganathan K, Mirvis S E, Boyd-Kranis R, Takada T, Scalea T M. Nonsurgical management of blunt splenic injury: use of CT criteria to select patients for splenic arteriography and potential endovascular therapy.  Radiology. 2000;  217 75-82
• 29 Haan J, Scott J, Boyd-Kranis R L et al.. Admission angiography for blunt splenic injury: advantages and pitfalls.  J Trauma. 2001;  51 1161-1165
• 30 Kidney D D. The endovascular approach to trauma. In: Dyet JF, Ettles DF, Nicholson AA, Wilson S Textbook of Endovascular Procedures, 1st ed. Philadelphia; Churchill Livingston 2000: 313-327
• 31 Richardson D J, Franklin G A, Lukan J K et al.. Evolution in the management of hepatic trauma: a 25 year perspective.  Ann Surg. 2000;  232 324-330
• 32 Carrillo E H, Platz A, Miller F B, Richardson J D, Polik H C. Non-operative management of blunt hepatic trauma.  Br J Surg. 1998;  85 461-468
• 33 Asensio J A, Demetriades D, Chahwan S et al.. Approach to the management of complex hepatic injuries.  J Trauma. 2000;  48 66-69
• 34 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
• 35 Hagiwara A, Yukioka T, Ohat S et al.. Nonsurgical management of patients with blunt hepatic injury: efficacy of transcatheter arterial embolization.  AJR Am J Roentgenol. 1997;  169 1151-1156
• 36 Hashimoto S, Hiramatsu K, Ido K et al.. Expanding role of emergency embolization in the management of sever blunt hepatic trauma.  Cardiovasc Intervent Radiol. 1990;  13 193-199
• 37 Snyder W H, Thal E R, Bridges R A. The validity of normal arteriography in penetrating trauma.  Arch Surg. 1978;  113 424-428
• 38 Frykberg E R, Dennis J W, Bishop K, Laneve L, Alexander R H. The reliability of physical examination in the evaluation of penetrating extremity trauma for vascular injury: results at one year.  J Trauma. 1991;  31 502-511
• 39 Frykberg E R. Advances in the diagnosis and treatment of extremity vascular trauma.  Surg Clin North Am. 1995;  75 207-223
• 40 Reid S K, Kirchner T M, Pagan-Marin H. Arteriography and intervention in extremity trauma.  Semin Interv Radiol. 1991;  14 193-204
• 41 Francis H, Thal E R, Weigelt J A, Redman H C. Vascular proximity: is it a valid indication for arteriography in asymptomatic patients.  J Trauma. 1991;  31 512-514
• 42 Scalfani S JA, Shaftan G W. Transcatheter treatment of injuries to the profunda femoris artery.  AJR Am J Roentgenol. 1982;  138 463-466