Solid Organ Trauma

Robin Boyd-Kranis

doi:10.1055/s-2003-43312

Seminars in Interventional Radiology, Table of Contents

Semin intervent Radiol 2003; 20(2): 071-080
DOI: 10.1055/s-2003-43312

Solid Organ Trauma

Robin Boyd-Kranis

Interventional Radiologist, Forsyth Radiological Associates, Winston-Salem, North Carolina

Abstract

ABSTRACT

Nonoperative management (NOM) can now be applied to the majority of solid organ injuries. Interventional radiology techniques have great potential to improve the success rates of NOM by treating those patients who are at risk of or who are failing NOM. In other patients interventional techniques may be used as an adjunct to surgery. The purpose of this article is to review the diagnosis and treatment of solid organ injury with emphasis on the role of interventional techniques for management of vascular injuries involving the liver, spleen, and kidneys.

KEYWORDS

Transarterial embolization - blunt trauma - nonoperative treatment

Full Text

References

REFERENCES

1 Shanmuganathan K, Mirvis S, Sover E. Value of contrast-enhanced CT in detecting active hemorrhage in patients with blunt abdominal or pelvic trauma. AJR Am J Roentgenol . 1993; 161 65-69
2 Schurr M J, Favian T C, Gavant M. et al . Management of blunt splenic trauma: computed tomographic contrast blush predicts failure of nonoperative management. J Trauma . 1995; 39 507-513
3 Gavant M L, Schurr M, Lick P A, Croce M A, Fabian T C, Gold R E. Predicting clinical outcome of nonsurgical management of blunt splenic injury: using CT to reveal abnormalities of splenic vasculature. AJR Am J Roentgenol . 1997; 168 207-212
4 Federle M P, Courcoulas A P, Powell M, Ferris J V, Peitzman A B. Blunt splenic injury in adults: clinical and CT criteria for management, with emphasis on active extravasation. Radiology . 1998; 206 137-142
5 Sclafani S JA, Shaftan G W, Scalea T M. Nonoperative salvage of computed tomography-diagnosed splenic injuries: utilization of angiography for triage and embolization for hemostasis. J Trauma . 1995; 39 818-827
6 Hagiwara A, Yukioka T, Ohta S. et al . Nonsurgical management of patients with blunt hepatic injury: efficacy of transcatheter arterial embolization. AJR Am J Roentgenol . 1997; 169 1151-1156
7 Hagiwara A, Yukioka T, Ohta S, Nitatori T, Matsuda H, Shimazaki S. Nonsurgical management of patients with blunt splenic injury: efficacy of transcatheter arterial embolization. AJR Am J Roentgenol . 1996; 167 159-166
8 Hagiwara A, Sakaki S, Goto H. et al . The role of interventional radiology in the management of blunt renal injury: a practical protocol. J Trauma . 2001; 51 526-531
9 Moore E E, Shackford S R, Pachter H L. et al . Organ injury scaling: spleen, liver, and kidney. J Trauma . 1989; 29 1664
10 Moore E E, Cogbill T H, Jurkovich G J, Shackford S R, Malangoni M A, Champion H R. Organ injury scaling: spleen and liver (1994 revision). J Trauma . 1995; 38 323-324
11 Felician D V, Moore E E, Mattox K L. Trauma. 3rd ed. Stamford, CT: Appleton & Lange 1996: 487-493
12 Croce M A, Fabian T C, Menke P G. et al . Nonoperative management of blunt hepatic trauma is the treatment of choice for hemodynamically stable patients. Ann Surg . 1995; 221 744-755
13 Pachter H L, Knudson M M, Esrig B. et al . Status of nonoperative management of blunt hepatic injuries in 1995; a multicenter experience with 404 patients. J Trauma . 1996; 40 31-38
14 Malhotra A J, Fabian T C, Croce M A. et al . Blunt hepatic injury: a paradigm shift from operative to nonoperative management in the 1990's. Ann Surg . 2000; 231 804-813
15 Richardson J D, Franklin G A, Lukan J K. et al . Evolution in the management of hepatic trauma: a 25-year perspective. Ann Surg . 2000; 232 324-330
16 Cogbill T H, Moore E E, Jurkovich G J. et al . Severe hepatic trauma: a multi-center experience with 1335 liver injuries. J Trauma . 1988; 28 1433-1438
17 Asensio J A, Demetriades D, Chahwan S. et al . Approach to the management of complex hepatic injuries. J Trauma . 2000; 48 66-69
18 Denton J R, Moore E E, Coldwell D M. Multimodality treatment for grade V hepatic injuries: perihepatic packing, arterial embolization and venous stenting. J Trauma . 1997; 42 964-967
19 Villalba M R, Howells G A, Lucas R J. et al . Nonoperative management of the adult ruptured spleen. Arch Surg . 1990; 125 836-839
20 Smith Jr S J, Cooney R N, Mucha Jr P. Nonoperative management of the ruptured spleen: a revalidation of criteria. Surgery . 1996; 120 745-750
21 Pachter H L, Guth A A, Hofstetter S R, Spencer F C. Changing patterns in the management of splenic trauma: the impact of nonoperative management. Ann Surg . 1998; 227 708-717
22 Cogbill T H, Moore E E, Jurkovich G J. et al . Nonoperative management of blunt splenic trauma: a multicenter experience. J Trauma . 1989; 29 1312-1317
23 Godley C D, Warren R L, Sheridan R L, McCabe C J. Nonoperative management of blunt splenic injury in adults: age over 55 years as a powerful indicator for failure. J Am Coll Surg . 1996; 183 133-139
24 Brasel K J, Delisle C M, Olson C J, Borgstrom D C. Splenic injury: trends in evaluation and management. J Trauma . 1998; 4 283-286
25 Smith Jr S L, Wengrovitz M A, Delong B S. Prospective validation of criteria, including age, for safe, nonsurgical management of the ruptured spleen. J Trauma . 1992; 33 363-369
26 Buntain W L, Gould H R, Maull K I. Predictability of splenic salvage by computed tomography. J Trauma . 1988; 28 24-31
27 Resciniti A, Fink M P, Raptopoulos V, Davidoff A, Silva W E. Nonoperative treatment of adult splenic trauma: development of a computed tomography scoring system that detects appropriate candidates for expectant management. J Trauma . 1988; 28 828-831
28 Mirvis S E, Whitley N O, Gens D R. Blunt splenic trauma in adults: CT-based classification and correlation with prognosis and treatment. Radiology . 1989; 171 33-39
29 Umlas S L, Cronan J J. Splenic trauma: can CT grading systems enable prediction of successful nonsurgical treatment?. Radiology . 1991; 178 481-487
30 Becker C D, Spring P, Glattli A, Schweizer W. Blunt splenic trauma in adults: can CT findings be used to determine the need for surgery?. AJR Am J Roentgenol . 1994; 162 343-347
31 Kohn J S, Clark D E, Isler R J, Pope C F. Is computed tomographic grading of splenic injury useful in the nonsurgical management of blunt trauma?. J Trauma . 1994; 36 385-389
32 Shanmuganathan K, Mirvis S, Boyd-Kranis R, Takada T, Scalea T. Nonsurgical management of blunt splenic injury: use of CT criteria to select patients for splenic arteriography and potential endovascular therapy. Radiology . 2000; 217 75-82
33 Davis K A, Fabian T C, Croce M A. et al . Improved success in nonoperative management of blunt splenic injuries: embolization of splenic artery pseudoaneurysms. J Trauma . 1998; 44 1008-1013
34 Sclafani S JA, Weisberg A, Scalea T M, Phillips T F, Duncan A O. Blunt splenic injuries: nonsurgical treatment with CT, arteriography and transcatheter arterial embolization of the splenic artery. Radiology . 1991; 181 189-196
35 Haan J, Scott J, Boyd-Kranis R, Ho S, Kramer M, Scalea T M. Admission angiography for blunt splenic injury:advantages and pitfalls. J Trauma . 2001; 51 1161-1166
36 Salis A, Pais O, Scalea T. et al . Superselective embolization of a traumatic intrasplenic arteriovenous fistula. J Trauma . 1999; 46 186-188
37 Matthews L A, Spirnak J P. The nonoperative approach to major blunt renal trauma. Semin Urol . 1995; 13 77-82
38 Altman A L, Haas C, Dinchman K H, Spirnak J P. Selective nonoperative management of blunt grade 5 renal injury. J Urol . 2000; 164 27-31
39 Peterson N E. Genitourinary trauma. Feliciano DV, Moore EE, Mattox KL, eds. Trauma 3rd ed. Stamford, CT: Appleton & Lange 1996: 661-694
40 Harris A C, Zwirewich C V, Lyburn I D, Torreggiani W C, Marchinkow L O. CT findings in blunt renal trauma. Radiographics . 2001; 21 S201-214
41 Bruce L M, Croce M A, Santaniello J M, Miller P R, Lyden S P, Fabian T C. Blunt renal artery injury: incidence, diagnosis, and management. Am Surg . 2001; 67 555-556