The Expanding Role of Endoluminal Therapy for Hemorrhage in Trauma

OBJECTIVES:
Embolization to control hemorrhage trauma is becoming increasingly common with the shift in clinical management of trauma to non-operative approaches. The spectrum of endovascular therapy is expanding and the demands on the interventionalist are increasing. The natural history and outcomes of endovascular interventions for hemorrhage following trauma have not been well defined.
METHODS:
We reviewed the Trauma Registry for a Metropolitan Level I trauma center with a dedicated vascular interventional service that has twenty-four hour access to interventional suites. The registry was queried from 2003 to 2006 with ICD-9 codes for angiographic embolization and the records of those patients reviewed for factors such as age, sex, mechanism of injury, injury severity score (ISS), therapy provided, complications and outcomes.

RESULTS:
Embolization has increased over the period of the study with a shift toward treatment of solid organ injuries. 63 procedures were performed in 45 patients. The majority of patients (93%) suffered blunt trauma and therapy was for acute hemorrhage (2/45 patients presented with delayed hemorrhage). Embolization was performed for thirty-three hypogastric injuries (52%), seven splenic injuries (11%), five renal injuries (8%), five hepatic injuries (8%) and one mesenteric branch injury (1%). Outside the abdomen, eight head and neck (13%) and four upper extremity vessels were embolized (6%). Technical success was 100%, re-intervention rate was 0% and specific procedure related morbidity was 1.5%.

CONCLUSIONS:
Embolization of pelvic and parenchymal injuries after blunt and penetrating trauma is increasing but can be performed safely with good outcomes in a high-risk patient population given an appropriate environment. As a result, there will be increasing demands on the endovascular therapist in the selective non-operative management of blunt and penetrating trauma.