Interventional radiologists’ expertise essential in trauma embolization

Miguel Angel de Gregorio

With traumatic injuries caused by traffic accidents on the rise, Miguel Angel de Gregorio provides an overview of interventional radiologists’ role in performing embolization procedures to help the increasing number of trauma patients. De Gregorio also summarises the work presented at the Cardiovascular and Interventional Radiological Society of Europe 2018 meeting (CIRSE; 22–25 September, Lisbon, Portugal) on the Embolization for Trauma panel.

Despite preventative measures, no one can doubt that many technological advances have brought a considerable increase in the incidence of serious accidents that manifest themselves in incapacitating and even fatal injuries. This increase in accident rates is closely linked to traffic accidents. According to the National Transportation Society Board (NTBS), in the year 2016 in the USA, more than 40,000 deaths were due to traffic accidents—involving a mean of 12.4 people per 100,000 inhabitants. The measures of prevention and control of road safety, together with an improvement in the social conscience of drivers and workers, should reduce the rate of any type of accidents as well as their mortality.

Life support measures, coupled with emergency surgery, play an important role in the management of injured patients who arrive at hospitals. Through embolization procedures, interventional radiology can contribute to the good management and stabilisation of these serious patients in a simple and safe way.

The CIRSE 2018 (Cardiovascular Interventional Radiological Society of Europe) Congress held on 22–15 September in Lisbon, Portugal, included the presentation and discussion of several papers covering trauma and vascular embolization.

Sanja Stojanović and myself moderated the session Embolization for Trauma, in which Christian Scheuring-Meunkler (Berlin, Germany), Michele Citone (Florence, Italy), Dimitrios Karnabatidis (Patras, Greece) and Gary Siskin (Albany, USA) discussed the management of trauma of the spleen, liver, pelvis, and kidney, respectively.

In general, after life support measures, radiological imaging plays an important role in the diagnosis and extension of patients’ trauma. Computed tomography (CT) is the most important imaging technique, enabling a simple, safe and rapid way for the diagnosis of affected organs, as well as for detecting the presence of active bleeding. The image data and clinical assessment establishes the severity of the trauma and also helps to classify the trauma.

The World Society of Emergency Surgery (WSES) assesses four types of closed or open traumas depending on the intensity of the trauma and the anatomical lesions observed. The Organ Injury Scaling Committee for the American Association for the Surgery of Trauma (AAST) divides the type of lesions according to the degree of anatomical lesion (IV grades). Patients with severe trauma—WSES type IV and an AAST grade of AAST (ranging from I–V)—and haemodynamic instability require surgical management (operative management), while in other degrees and levels, haemodynamic stability can be managed without surgery; this is non-operative management. In these latter types, patients are graded as WSES type I–II trauma. If angioCT and, most importantly, angiography establish vascular injury, embolization should be considered the treatment of choice.

There are many types of embolization agents, such as: absorbent gelatins, particles, gel foam, glues, coils, plugs alone or in combination. Embolization requires expertise, and interventional radiologists need to carefully decide which technique to use, such as distal, proximal embolization or combined, depending on the type of injury and the vascular anatomy of the organ or structure to be treated. Clinical results depend on the type of injury and the affected organ with few complications if the technique is adequate.

Endovascular techniques play an increasingly important role in the management of open and closed traumas with extensive vascular bleeding and injury; either to stabilise the patient, or to solve the problem. Hybrid operating rooms near hospital emergency centres can improve the results by reducing intervention times, as well as allowing surgery before, during, or after embolization without mobilising the patient.

Miguel Angel de Gregorio is a professor at the University of Zaragoza, Zaragoza, Spain, and a member of the Minimally Invasive Techniques Research Group (GITMI), Government of Aragon, Spain.


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