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Keywords:
Interventional vascular, Abdomen, Trauma, Catheter arteriography, CT-Angiography, PACS, Angioscopy, Arterial access, Embolisation, Acute, Haemorrhage, Outcomes
Authors:
M. Perri, A. V. Giordano, S. Carducci, M. Varrassi, C. Marsecano, G. Michelini, L. Sacchetti, M. Gallucci, C. Masciocchi; L'Aquila/IT
DOI:
10.1594/ecr2015/C-1820
Aims and objectives
Selective angiography and embolization is an effective treatment for traumatic and non-traumatic arterial hemorrhage (1–2).
Endovascular embolization for abdominal arterial hemorrhage is an established treatment for managing hemodynamically unstable patients (3,
4).
Accurate,
prompt identification of the damaged artery during the treatment session is essential for timely control of hemorrhage.
One of the most important occurrences nontraumatic is acute gastro-intestinal(GI) bleeding having mortality rate with ranges 8% to 14% (5–6) and 21%– 40% in cases of massive bleeding associated with hemodynamic instability (7,
8,9).
Transarterial embolization(TAE) represents the most viable treatment option in patients receiving anticoagulation therapy for various diseases(10,11) (atrial fibrillation,
valvular heart disease,
prophylaxis of deep vein thrombosis and pulmonary thromboembolism) with spontaneous extraperitoneal hemorrhage (EES) with an annual incidence of 0.2-3%(12,13).
Also in the management of severe postpartum bleeding (14) and other ginecological emergencies,
arterial embolization provides high clinical success rate.
Intraperitoneal bleedings and severe hemobilia can occur also after percutaneous transhepatic cholangial drainage (PTCD),
consequently causing life-threatening hemorrhagic shock,
which has a high mortality rate (nearly 50%)(15); superselective angiography has been developed as an effective method for the diagnosis and embolization of liver arterial bleedings(16).
Transarterial embolization (TAE) plays a role in the management of traumatic abdominal organs bleeding; the most commonly organs injured include spleen and liver,
that occur as a result of blunt or penetrating trauma.
Less frequently abdominal bleeding involves kidney,
mesentery,
adrenal gland,
small bowel,
or pancreas.
In cases of liver trauma is estimated that 50 to 80% of patients are able to undergo non surgical bleeding management in 98.5%(17).
Also a recent series of consensus documents on genitourinary trauma highlights the endovascular evaluation and management of renal injuries(18).
Superselective TAE preserves renal function,
sometimes better than surgery(19).
In trauma with bone fractures some surgeons advocate prompt stabilization of the bony pelvis,
although others prefer immediate TAE(20).
Pelvic fractures alone are associated with mortality rates of 5.6 to 15%,
but the addition of hemorrhagic shock raises mortality rates to 36.4 to 54%(21).
Associated organ injuries have been found in 11 to 20.3%(21) injuries with increased morbidity and mortality.
Many of these traumatic and nontraumatic eventualities were considered in this study and,
on the basis of our experience of last ten years,
the aim was to evaluate retrospectively the efficacy of interventional radiology (IR) procedures in the treatment of acute abdominal bleedings in theese conditions; our primary goals were to evaluate the indications,
methods and results of interventional treatments; our secondary goals were to evaluate the efficacy of different types of embolic materials (coils and resorbable agents) used during the procedures.