Visceral Trauma: Principles of Management and Role of Embolotherapy

ABSTRACT

Interventional radiology for the treatment of traumatic visceral hemorrhage has emerged as an important adjunct to modern trauma care. This article outlines the general surgical concepts of the acute care of trauma patients as a guideline for catheter-based therapy. Specific considerations are presented for embolizing visceral injuries in the liver, spleen, and kidney. Expected outcomes and follow-up are reviewed.

KEYWORDS

Trauma - hepatic hemorrhage - splenic embolization - hepatic embolization - renal embolization - damage control laparotomy

REFERENCES

• 1 Feliciano D V, Mattox D L, Moore E E. Trauma. 6th ed. San Francisco; McGraw-Hill 2008: 1430
• 2 Kashuk J L, Moore E E, Millikan J S, Moore J B. Major abdominal vascular trauma–a unified approach.  J Trauma. 1982;  22(8) 672-679
• 3 Johnson J W, Gracias V H, Schwab C W et al.. Evolution in damage control for exsanguinating penetrating abdominal injury.  J Trauma. 2001;  51(2) 261-269 discussion 269-271
• 4 Parr M J, Alabdi T. Damage control surgery and intensive care.  Injury. 2004;  35(7) 713-722
• 5 Department of Defense .Surface ship survivability. Naval War Publication 3-20.31. Washington, DC; U.S. Government Printing Office 1996
• 6 Rotondo M F, Schwab C W, McGonigal M D et al.. ‘Damage control’: an approach for improved survival in exsanguinating penetrating abdominal injury.  J Trauma. 1993;  35(3) 375-382 discussion 382-3373
• 7 Hoffer E K, Borsa J J, Bloch R D, Fontaine A B. Endovascular techniques in the damage control setting.  Radiographics. 1999;  19(5) 1340-1348
• 8 David Richardson J, Franklin G A, Lukan J K et al.. Evolution in the management of hepatic trauma: a 25-year perspective.  Ann Surg. 2000;  232(3) 324-330
• 9 Johnson J W, Gracias V H, Gupta R et al.. Hepatic angiography in patients undergoing damage control laparotomy.  J Trauma. 2002;  52(6) 1102-1106
• 10 Hagiwara A, Murata A, Matsuda T, Matsuda H, Shimazaki S. The usefulness of transcatheter arterial embolization for patients with blunt polytrauma showing transient response to fluid resuscitation.  J Trauma. 2004;  57(2) 271-276 discussion 276-277
• 11 Asensio J A, Demetriades D, Chahwan S et al.. Approach to the management of complex hepatic injuries.  J Trauma. 2000;  48(1) 66-69
• 12 Asensio J A, Roldán G, Petrone P et al.. Operative management and outcomes in 103 AAST-OIS grades IV and V complex hepatic injuries: trauma surgeons still need to operate, but angioembolization helps.  J Trauma. 2003;  54(4) 647-653 discussion 653-644
• 13 Kozar R A, Moore J B, Niles S E et al.. Complications of nonoperative management of high-grade blunt hepatic injuries.  J Trauma. 2005;  59(5) 1066-1071
• 14 Michels N A. Blood Supply and Anatomy of the Upper Abdominal Organs with a Descriptive Atlas. Philadelphia; Lippincott 1955
• 15 Winter III T C, Nghiem H V, Freeny P C, Hommeyer S C, Mack L A. Hepatic arterial anatomy: demonstration of normal supply and vascular variants with three-dimensional CT angiography.  Radiographics. 1995;  15(4) 771-780
• 16 Bauer J R, Ray C E. Transcatheter arterial embolization in the trauma patient: a review.  Semin Interv Radiol. 2004;  21(1) 11-22
• 17 Monnin V, Sengel C, Thony F et al.. Place of arterial embolization in severe blunt hepatic trauma: a multidisciplinary approach.  Cardiovasc Intervent Radiol. 2008;  , February 5 (Epub ahead of print)
• 18 Velmahos G C, Chahwan S, Falabella A, Hanks S E, Demetriades D. Angiographic embolization for intraperitioneal and retroperitoneal injuries.  World J Surg. 2000;  24(5) 539-545
• 19 Cox J C, Fabian T C, Maish III G O et al.. Routine follow-up imaging is unnecessary in the management of blunt hepatic injury.  J Trauma. 2005;  59(5) 1175-1178 discussion 1178-1180
• 20 Liu P P, Lee W C, Cheng Y F et al.. Use of splenic artery embolization as an adjunct to nonsurgical management of blunt splenic injury.  J Trauma. 2004;  56(4) 768-772 discussion 773
• 21 Haan J M, Bochicchio G V, Kramer N, Scalea T M. Nonoperative management of blunt splenic injury: a 5-year experience.  J Trauma. 2005;  58(3) 492-498
• 22 Ochsner M G. Factors of failure for nonoperative management of blunt liver and splenic injuries.  World J Surg. 2001;  25(11) 1393-1396
• 23 Haan J M, Biffl W, Knudson M M et al.. Splenic embolization revisited: a multicenter review.  J Trauma. 2004;  56(3) 542-547
• 24 Sclafani S J. The role of angiographic hemostasis in salvage of the injured spleen.  Radiology. 1981;  141(3) 645-650
• 25 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(6) 1008-1013 discussion 1013-1005
• 26 Weinberg J A, Magnotti L J, Croce M A, Edwards N M, Fabian T C. The utility of serial computed tomography imaging of blunt splenic injury: still worth a second look?.  J Trauma. 2007;  62(5) 1143-1147 discussion 1147-1148
• 27 Miller K S, McAninch J W. Radiographic assessment of renal trauma: our 15-year experience.  J Urol. 1995;  154(2 Pt 1) 352-355
• 28 Dinkel H P, Danuser H, Triller J. Blunt renal trauma: minimally invasive management with microcatheter embolization experience in nine patients.  Radiology. 2002;  223(3) 723-730
• 29 Huppert P E, Duda S H, Erley C M et al.. Embolization of renal vascular lesions: clinical experience with microcoils and tracker catheters.  Cardiovasc Intervent Radiol. 1993;  16(6) 361-367
• 30 Chatziioannou A, Brountzos E, Primetis E et al.. Effects of superselective embolization for renal vascular injuries on renal parenchyma and function.  Eur J Vasc Endovasc Surg. 2004;  28(2) 201-206
• 31 Corr P, Hacking G. Embolization in traumatic intrarenal vascular injuries.  Clin Radiol. 1991;  43(4) 262-264