Purpose
The purpose of our study was to evaluate the frequency and spectrum of interventional procedures in acute trauma patients after multidetector-row computed tomography (MDCT) of the chest and/or abdomen in the emergency room of a large Level 1 trauma center during a 4 year period.
Methods and Materials
A retrospective search of the center´s inpatient database from 12/2008 until 09/2012 was performed for the following criteria: MDCT of chest and/or abdomen and an interventional procedure within 7 days thereafter.
MDCT is effective in detecting active arterial traumatic and nontraumatic bleeding and dedicated protocols have been described more than 10 years ago (1,2).
All MDCT studies were performed in the arterial and venous phase on a Siemens Sensation Open 40 row- MDCT (Siemens Medical Solutions,
Erlangen,
Germany) with the following parameters 100 kV,
mAs...
Results
The total number of chest MDCT´s in the emergency room after acute trauma was 395.
In 19 patients (4.8%),
interventional radiological procedures were performed.
In seven patients (37%),
branches of the iliac or renal artery were selectively embolized.
In ten patients (53%),
an endovascular thoracic stentgraft was applied due to type-B-dissection or traumatic transsection of the thoracic aorta.
Fig.1.
and 2 show contrast enhanced axial and coronal MPRs of a traumatic aortic transsection and pseudoaneurysm after an MVA in a 30 year old male.
The...
Conclusion
In up to 4.8% of acute trauma patients,
emergency interventional radiological procedures were performed in our department with the majority being stentgrafts of the thoracic aorta.
The second most common endovascular procedure was embolization of the internal iliacal artery for pelvic haemorrhage (6,7) followed by embolization of branches of the renal artery (8).
Interventional procedures are an important tool in the management of the actively bleeding trauma patient and in selected cases can obviate the need for emergent major surgical procedures.
References
1.Krestan CR,
Pokieser P,
Wenzl E,et al.
Localization of gastrointestinal bleeding with contrast-enhanced helical CT.
AJR Am J Roentgenol.
2000 Jan;174(1):265-6.
2.
Uyeda J,
Anderson SW,
Kertesz J,
et al.
Pelvic CT angiography: application to blunt trauma using 64MDCT.
Emerg Radiol.
2010 Mar;17(2):131-7.
3.
Orend KH,
Zarbis N,
Schelzig H,et al.
Endovascular treatment (EVT) of acute traumatic lesions of the descending thoracic aorta--7 years' experience.
Eur J Vasc Endovasc Surg.
2007 Dec;34(6):666-72.
4.
Mohseni S,
Talving P,
Kobayashi L,
et al.
The diagnostic accuracy of...
Personal Information
Christian R.
Krestan MD,
Department of Radiology,
Division of General and Pediatric Radiology,
Vienna General Hospital,
Medical University of Vienna,
Vienna,
Austria
[email protected]
Stephanie Arbes MD,
MBA,
Department of Trauma Surgery,
Vienna General Hospital,
Medical University of Vienna,
Vienna,
Austria
[email protected]
Florian Wolf MD,
Department of Radiology,
Division of Cardiovascular and Interventional Radiology,
Vienna General Hospital,
Medical University of Vienna,
Vienna,
Austria
[email protected]
Martin Funovics MD,
Department of Radiology,
Division of Cardiovascular and Interventional Radiology,
Vienna General Hospital,
Medical University of Vienna,
Vienna,
Austria
[email protected]