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World Journal of Emergency Surgery
Published in: World Journal of Emergency Surgery 1/2010

Open Access 01-12-2010 | Review

Angiography and embolisation for solid abdominal organ injury in adults - a current perspective

Authors: Adam Wallis, Michael D Kelly, Lyn Jones

Published in: World Journal of Emergency Surgery | Issue 1/2010

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Abstract

Over the past twenty years there has been a shift towards non-operative management (NOM) for haemodynamically stable patients with abdominal trauma. Embolisation can achieve haemostasis and salvage organs without the morbidity of surgery, and the development and refinement of embolisation techniques has widened the indications for NOM in the management of solid organ injury. Advances in computed tomography (CT) technology allow faster scanning times with improved image quality. These improvements mean that whilst surgery is still usually recommended for patients with penetrating injuries, multiple bleeding sites or haemodynamic instability, the indications for NOM are expanding.
We present a current perspective on angiography and embolisation in adults with blunt and penetrating abdominal trauma with illustrative examples from our practice including technical advice.
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Literature
1.
2.
Deunk J, Brink M, Dekker HM, et al.: Predictors for the selection of patients for abdominal CT after blunt trauma: a proposal for a diagnostic algorithm. Ann Surg. 2010, 251 (3): 512-520. 10.1097/SLA.0b013e3181cfd342.CrossRefPubMed
3.
Fang JF, Wong YC, Lin BC, et al.: Usefulness of multidetector computed tomography for the initial assessment of blunt abdominal trauma patients. World J Surg. 2006, 30: 176-182. 10.1007/s00268-005-0194-7.CrossRefPubMed
4.
Zealley IA, Chakraverty S: The role of interventional radiology in trauma. BMJ. 2010, 340: c497-10.1136/bmj.c497.CrossRefPubMed
5.
Hilbert P, zur Nieden K, Hofmann GO, et al.: New aspects in the emergency room management of critically injured patients A multislice CT-orientated care algorithm. Injury. 2007, 38: 552-558. 10.1016/j.injury.2006.12.023.CrossRefPubMed
6.
Weninger P, Mauritz W, Fridrich P, et al.: Emergency room management of patients with blunt major trauma evaluation of the multislice computed tomography protocol exemplified by an urban trauma center. J Trauma. 2007, 62: 584-591. 10.1097/01.ta.0000221797.46249.ee.CrossRefPubMed
7.
American College of Surgeons: ATLS. Advanced Trauma Life Support Programme for Doctors. ACS. 2008
8.
Kessel D: Trauma embolisation: techniques. Presented at CIRSE 2009. 2009
9.
Haan JM, Bochicchio GV, Kramer N, et al.: Nonoperative management of blunt splenic injury: a 5-year experience. J Trauma. 2005, 58: 492-498. 10.1097/01.TA.0000154575.49388.74.CrossRefPubMed
10.
Bass EM, Crosier JH: Percutaneous control of post-traumatic hepatic haemorrhage by gelfoam embolisation. J Trauma. 1977, 17: 61-63. 10.1097/00005373-197701000-00009.CrossRefPubMed
11.
Maddison F: Embolic therapy of hypersplenism. Invest Radiol. 1973, 8: 280-281. 10.1097/00004424-197307000-00054.CrossRef
12.
Papadimitriou J, Tritakis C, Karatzas G: Treatment of hypersplenism by embolus placement in the splenic artery. Lancet. 1976, 11: 1268-1270. 10.1016/S0140-6736(76)92030-4.CrossRef
13.
Sclafani SJ: The role of angiographic haemostasis in salvage of the injured spleen. Radiology. 1981, 141: 645-650.CrossRefPubMed
14.
Ochsner MG: Factors of failure for nonoperative management of blunt liver and splenic injuries. World J Surg. 2001, 25: 1393-1396.PubMed
15.
Hagiwara a, Fukushima H, Murata A, et al.: Blunt splenic injury: Usefulness of Transcatheter Arterial Embolization in Patients with a Transient Response to Fluid Resuscitation. Radiology. 2005, 235: 57-64. 10.1148/radiol.2351031132.CrossRefPubMed
16.
Hilty MP, Behrendt I, Benneker LM, et al.: Pelvic radiography in ATLS algorithms: A diminishing role?. WJES 2008. 2008, 3: 11.
17.
Velmahos GC, Demetriades D, Chahwan S, et al.: Angiographic embolisation for Arrest of Bleeding after Penetrating Trauma to the Abdomen. Am J Surg. 1999, 178: 367-373. 10.1016/S0002-9610(99)00212-3.CrossRefPubMed
18.
Velmahos GC, Chahwan S, Falabella A, et al.: Angiographic embolisation for intraperitoneal and retroperitoneal injuries. World J Surg. 2000, 24: 539-545. 10.1007/s002689910087.CrossRefPubMed
19.
Velmahos GC, Toutouzas KG, Vassiliu P, et al.: A prospective study on the safety and efficacy of angiographic embolisation for pelvic and visceral injuries. J Trauma. 2002, 53: 303-308. 10.1097/00005373-200208000-00019.CrossRefPubMed
20.
Mehran R, Aymong ED, Nikolsky E, et al.: A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation. J Am Coll Cardiol. 2004, 44: 1393-9.PubMed
21.
Yao DC, Jeffrey RB, Mirvis SE, et al.: Using Contrast-Enhanced Helical CT to Visualise Arterial Extravasation After Blunt Abdominal Trauma: Incidence and Organ Distribution. AJR. 2002, 178: 17-20.CrossRefPubMed
22.
Willmann JK, Roos JE, Platz A, et al.: Multidetector CT: Detection of Active Haemorrhage in Patients with Blunt Abdominal Trauma. AJR. 2002, 179: 437-444.CrossRefPubMed
23.
Cox EF: Blunt abdominal trauma: A five year analysis of 870 patients following celiotomy. Ann Surg. 1984, 199: 467-474. 10.1097/00000658-198404000-00015.PubMedCentralCrossRefPubMed
24.
Goan TG, Huang MS, Lin JM: Nonoperative management for extensive hepatic and splenic injuries with significant haemoperitoneum in adults. J Trauma. 1998, 44: 491-695.
25.
Barone JE, Burns G, Svehlak SA, et al.: Management of blunt splenic trauma in patients older than 55 years: Southern Connecticut Regional Trauma Quality Assurance Committee. J Trauma. 1999, 46: 87-90. 10.1097/00005373-199901000-00014.CrossRefPubMed
26.
Pachter HL, Guth AA, Hofstetter SR, et al.: Changing patterns in the management of splenic trauma: the impact of nonoperative management. Ann Surg. 1998, 227: 708-717. 10.1097/00000658-199805000-00011.PubMedCentralCrossRefPubMed
27.
Wahl WL, Ahrns KS, Chen S, et al.: Blunt splenic injury: Operation versus angiographic embolization. J Surg. 2004, 136: 891-899. 10.1016/j.surg.2004.06.026.
28.
Anderson SW, Lucey BC, Rhea JT, et al.: 64 MDCT in multiple trauma patients: imaging manifestations and clinical implications of active extravasation. Emerg Radiol. 2007, 14: 151-159. 10.1007/s10140-007-0600-6.CrossRefPubMed
29.
Shanmuganathan K, Mirvis SE, Boyd-Kranis R, et al.: Nonsurgical management of blunt splenic injury: use of CT criteria to select patients for splenic angiography and potential endovascular therapy. Radiology. 2000, 217: 75-82.CrossRefPubMed
30.
Velmahos GC, Chan L, Kamel E, et al.: Nonoperative Management of Splenic Injuries. Have we gone too far? Arch Surg. 2000, 135: 674-681. 10.1001/archsurg.135.6.674.CrossRefPubMed
31.
Marmery H, Shanmuganathan K, Mirvis SE, et al.: Correlation of Multidetector CT Findings with Splenic Arteriography and Surgery: Prospective Study in 392 Patients. J Am Coll Surg. 2008, 206: 685-693.CrossRefPubMed
32.
Gavant ML, Schurr M, Flick PA, et al.: Predicting clinical outcome of nonsurgical management of blunt splenic injury: using CT to reveal abnormalities of splenic vasculature. AJR. 1997, 168: 207-212.CrossRefPubMed
33.
Thompson BE, Munera F, Cohn SM, et al.: Novel computed tomography scan scoring system predicts the need for intervention after splenic injury. J Trauma. 2006, 60: 1083-1086. 10.1097/01.ta.0000218251.67141.ef.CrossRefPubMed
34.
Rhodes CA, Dinan D, Jafri SZ, et al.: Clinical outcome of active extravasation in splenic trauma. Emerg Radiol. 2005, 11: 348-352. 10.1007/s10140-005-0416-1.CrossRefPubMed
35.
Marmery H, Shanmuganathan K, Alexander M, et al.: Optimization of Selection for Nonoperative Management of Blunt Splenic Injury: Comparison of MDCT Grading Systems. AJR. 2007, 189: 1421-1427. 10.2214/AJR.07.2152.CrossRefPubMed
36.
Norrman G, Tingstedt B, Ekelund M, et al.: Nonoperative Management of Blunt Splenic Trauma: Also Feasible and Safe in Centers with Low Trauma Incidence and in the Presence of Established Risk Factors. Eur J Trauma Emerg Surg. 2009, 35: 102-107. 10.1007/s00068-008-8108-7.CrossRefPubMed
37.
Dent D, Alsabrook G, Erikson BA, et al.: Blunt splenic injuries: high nonoperative management rate can be achieved with selective embolisation. J Trauma. 2004, 56: 1063-1067. 10.1097/01.TA.0000123037.66867.F2.CrossRefPubMed
38.
Wasvery H, Howells G, Villalba M, et al.: Nonoperative management of adult blunt splenic trauma: a 15 year experience. Am Surg. 1997, 63: 694-699.
39.
Schurr MJ, Fabian TC, Gavant M, et al.: Management of Blunt Splenic Trauma: Computed Tomographic Contrast Blush Predicts Failure of Nonoperative Management. J Trauma. 1995, 39: 507-512. 10.1097/00005373-199509000-00018.CrossRefPubMed
40.
Becker CD, Poletti P-A: The trauma concept: the role of MDCT in the diagnosis and management of visceral injuries. Eur Radiol Suppl. 2005, 15 (Suppl 4): D104-D109.
41.
Bessoud B, Denys A, Calmes JM, et al.: Nonoperative Management of Traumatic Splenic Injuries: Is There a Role for Proximal Splenic Artery Embolisation?. AJR. 2006, 186: 779-785. 10.2214/AJR.04.1800.CrossRefPubMed
42.
Sclafani SJ, Shaftan GW, Scalea TM, et al.: Non-operative salvage of computer-tomography diagnosed splenic injuries: utilisation of angiography for triage and embolisation for haemostasis. J Trauma. 1995, 39: 818-825. 10.1097/00005373-199511000-00004.CrossRefPubMed
43.
Sclafani SA, Weisberg A, Scalea T: Blunt splenic injuries: nonsurgical treatment with CT, arteriography, and transcatheter arterial embolisation of the splenic artery. Radiology. 1991, 181: 189-196.CrossRefPubMed
44.
Hagiwara A, Yukloka T, Ohat S, et al.: Nonsurgical management of patients with blunt splenic injury: efficacy of transcatheter arterial embolisation. AJR. 1996, 167: 156-166.CrossRef
45.
Ekeh AP, McCarthy MC, Woods RJ, et al.: Complications arising from splenic embolisation after blunt splenic trauma. Am J Surg. 2005, 189: 335-339. 10.1016/j.amjsurg.2004.11.033.CrossRefPubMed
46.
Gaarder C, Dormagen JB, Eken T, et al.: Nonoperative Management of Splenic Injuries: Improved Results with Angioembolisation. J Trauma. 2006, 61: 192-198. 10.1097/01.ta.0000223466.62589.d9.CrossRefPubMed
47.
van der Hul RL, van Overhagen H, Dallinga RJ, et al.: Splenic salvage by Superselective Embolisation after Blunt Abdominal Trauma. Eur J Surg. 2001, 167: 73-75.CrossRefPubMed
48.
Kaseje N, Agarwal S, Burch M, et al.: Short-term outcomes of splenectomy avoidance in trauma patients. Am J Surg. 2008, 196: 213-217. 10.1016/j.amjsurg.2007.07.037.CrossRefPubMed
49.
Kelly MD, Jones L: Splenic embolization for iatrogenic penetrating injury. ANZ J Surg 79. 2009, 393-4.
50.
Smith H, Biffl W, Majercik S, et al.: Splenic artery embolisation: have we gone too far?. J Trauma. 2006, 61: 541-546. 10.1097/01.ta.0000235920.92385.2b.CrossRefPubMed
51.
Croce MA, Fabian TC, Menke PG, et al.: Nonoperative management of blunt hepatic trauma is the treatment of choice for haemodynamically stable patients: results of a prospective trial. Ann Surg. 1995, 221: 744-753. 10.1097/00000658-199506000-00013.PubMedCentralCrossRefPubMed
52.
Haan JM, Biffl W, Knudson MM: Splenic embolisation revisited: a multicentre review. J Trauma. 2004, 56: 542-547. 10.1097/01.TA.0000114069.73054.45.CrossRefPubMed
53.
Gourgiotis S, Vougas V, Germanos S, et al.: Operative and nonoperative management of blunt hepatic trauma in adults: a single centre report. J Hepatobiliary Panreat Surg. 2007, 14: 387-391. 10.1007/s00534-006-1177-2.CrossRef
54.
Carillo EH, Platz A, Miller FB, et al.: Non-operative management of blunt hepatic trauma. Br J Surg. 1998, 85: 461-46. 10.1046/j.1365-2168.1998.00721.x.CrossRef
55.
Pachter Hl, Knudson NM, Esrig B, et al.: Status of nonoperative management of blunt hepatic injuries in 1995: a multicentre experience of 404 patients. J Trauma. 1996, 40: 31-38. 10.1097/00005373-199601000-00007.CrossRefPubMed
56.
Velmahos GC, Toutouzas KG, Radin R, et al.: High success with Nonoperative Management of Blunt Hepatic Trauma. Arch Surg. 2003, 138: 475-481. 10.1001/archsurg.138.5.475.CrossRefPubMed
57.
Carrillo EH, Spain DA, Wohltmann CD, et al.: Interventional techniques are useful adjuncts in nonoperative management of hepatic injuries. J Trauma. 1999, 46: 619-622. 10.1097/00005373-199904000-00010.CrossRefPubMed
58.
Kelly MD, Armstrong CP, Longstaff A: Characterisation of Biliary Injury from Blunt Liver Trauma by MRCP: Case Report. J Trauma. 2008, 64 (5): 1363-1365. 10.1097/TA.0b013e318075e84f.CrossRefPubMed
59.
Becker CD, Gal I, Baer HU, et al.: Blunt hepatic trauma in adults: correlation of CT injury grading with outcome. Radiology. 1996, 201: 215-222.CrossRefPubMed
60.
Mohr AM, Lavery RF, Barone A, et al.: Angiographic embolisation for liver injuries: low mortality, high morbidity. J Trauma. 2003, 55: 1077-1081. 10.1097/01.TA.0000100219.02085.AB.CrossRefPubMed
61.
Wahl WL, Ahrns KS, Brandy MM, et al.: The need for early angiographic embolisation in blunt liver injuries. J Trauma. 2002, 52: 1097-1101. 10.1097/00005373-200206000-00012.CrossRefPubMed
62.
Monnin V, Sengel C, Thony F, et al.: Place of Arterial Embolisation in Severe Blunt Hepatic Trauma: A Multidisciplinary Approach. Cardiovasc Intervent Radiol. 2008, 31: 875-882. 10.1007/s00270-007-9277-1.CrossRefPubMed
63.
Velmahos GC, Konstantinos GT, Radin R: Nonoperative Treatment of Blunt Injury to Solid Abdominal Organs. Arch Surg. 2003, 138: 844-851. 10.1001/archsurg.138.8.844.CrossRefPubMed
64.
Knudson MM, Maull KI, et al.: Nonoperative management of solid organ injuries: past, present and future. Surg Clin North Am. 1999, 79: 1357-1371. 10.1016/S0039-6109(05)70082-7.CrossRefPubMed
65.
Smith J, Caldwell E, D'Amours S, et al.: Abdominal trauma: a disease in evolution. ANZ J Surg. 2005, 75: 790-794. 10.1111/j.1445-2197.2005.03524.x.CrossRefPubMed
66.
Brandes SB, McAninch JW: Urban free falls and patterns of renal injury: a 20 year experience with 396 cases. J Trauma. 1999, 47: 643-649. 10.1097/00005373-199910000-00007.CrossRefPubMed
67.
Dunfee BL, Lucey BS, Soto JA: Development of Renal Scars on CT After Abdominal Trauma: Does Grade of Injury Matter?. AJR. 2008, 190: 1174-1179. 10.2214/AJR.07.2478.CrossRefPubMed
68.
McAnich JW, Carroll PR, Klosterman PW: Renal reconstruction after injury. J Urol. 1991, 145: 932-937.
69.
Dinkel HP, Danuser H, Triller J, et al.: Blunt renal trauma: minimally invasive management with microcatheter embolisation - experience in nine patients. Radiology. 2002, 223: 723-730. 10.1148/radiol.2233011216.CrossRefPubMed
70.
Sofocleous CT, Hinrichs C, Hubbi B, et al.: Angiographic Findings and Emblotherapy in Renal Arterial Trauma. Cardiovasc Intervent Radiol. 2005, 28: 39-47. 10.1007/s00270-004-0042-4.CrossRefPubMed
71.
Corr P, Hacking G: Embolisation in traumatic intrarenal vascular injuries. Clin Rad. 1991, 43: 262-264. 10.1016/S0009-9260(05)80252-1.CrossRef
72.
Chabrot P, Cassagnes L, Alfidia A, et al.: Revascularisation of traumatic renal artery dissection by endoluminal stenting: three cases. Acta Radiol. 2010, 51 (1): 21-26. 10.3109/02841850903473314.CrossRefPubMed
73.
Chow SJD, Thompson KJ, Hartman JF, et al.: A 10-year review of blunt renal artery injuries at an urban level 1 trauma centre. Injury 40. 2009, 844-850. 10.1016/j.injury.2008.11.022.
74.
Vignali C, Lonzi S, Bargellini I, et al.: Vascular injuries after percutaneous renal procedures: treatment by transcatheter embolisation. Eur Radiol. 2004, 14: 723-729. 10.1007/s00330-003-2009-2.CrossRefPubMed
75.
Tinkoff G, Esposito TJ, Reed J, et al.: American Association for the Surgery of Trauma Organ Injury Scale I: Spleen, Liver, and Kidney, Validation Based on the National Trauma Data Bank. J Am Coll Surg. 2008, 207: 646-655. 10.1016/j.jamcollsurg.2008.06.342.CrossRefPubMed
Metadata
Title
Angiography and embolisation for solid abdominal organ injury in adults - a current perspective
Authors
Adam Wallis
Michael D Kelly
Lyn Jones
Publication date
01-12-2010
Publisher
BioMed Central
Published in
World Journal of Emergency Surgery / Issue 1/2010
Electronic ISSN: 1749-7922
DOI
https://doi.org/10.1186/1749-7922-5-18

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