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- Title
Feasibility of intraoperative angioembolization for trauma patients using C-arm digital subtraction angiography.
- Authors
Alnumay, Abdulaziz; Caminsky, Natasha; Eustache, Jules Hugo; Valenti, David; Beckett, Andrew Neil; Deckelbaum, Dan; Fata, Paola; Khwaja, Kosar; Razek, Tarek; McKendy, Katherine Marlene; Wong, Evan Gordon; Grushka, Jeremy Richard
- Abstract
Purpose: Hemodynamically unstable trauma patients who would benefit from angioembolization (AE) typically also require emergent surgery for their injuries. The critical decision of transferring a patient to the operating room versus the interventional radiology (IR) suite can be bypassed with the advent of intra-operative AE (IOAE). Previously limited by the availability of costly rooms termed RAPTOR (resuscitation with angiography, percutaneous techniques and open repair) suites, it has been suggested that using C-arm digital subtraction angiography (DSA) is a comparable alternative. This case series aims to establish the feasibility and safety of IOAE. Methods: We conducted a retrospective analysis of all trauma patients at our level 1 trauma center who underwent IOAE with a concomitant surgical intervention from January 2011 to May 2019. Descriptive analyses were conducted. Results: A total of 49 patients (80% male, 44 ± 17 years, 92% blunt) underwent IOAE using the C-arm DSA during the study period. All but one patient underwent exploratory laparotomy, 56% of which underwent an additional surgical procedure (ex. exploratory thoracotomy, orthopedic). Either Gelfoam® (Pfizer, New York, USA) (90%), coils (2.0%), or a combination (8.2%) were used for embolization. Internal iliac embolization was performed in 88% of cases (59% bilateral). IOAE was successful in all but four cases (8.2%) and thirty-day mortality was 31%. Conclusion: IOAE appears to be a feasible and safe management option in severe trauma patients with the advantage of concurrent operative intervention and ongoing active resuscitation with good success in hemorrhage control.
- Subjects
QUEBEC (Province); DIGITAL subtraction angiography; ACADEMIC medical centers; RADIOEMBOLIZATION; INTRAOPERATIVE care; THERAPEUTIC embolization; PATIENTS; RETROSPECTIVE studies; THORACOTOMY; TREATMENT effectiveness; EMERGENCY medical services; CASE studies; DESCRIPTIVE statistics; ABDOMINAL surgery; WOUNDS &; injuries; EVALUATION
- Publication
European Journal of Trauma & Emergency Surgery, 2022, Vol 48, Issue 1, p315
- ISSN
1863-9933
- Publication type
Article
- DOI
10.1007/s00068-020-01530-x