Basic Principles of Trauma Embolization

Historically, a large number of traumatic injuries occurred on battlefields. Over many centuries, the management of traumatic injuries has evolved around battlefield injuries, and the substantial data and experience with those injured led to many new paradigms of management.[1] In the most recent military conflicts, battlefield deaths decreased significantly when compared with prior wars even in the setting of more advanced weapons. One of the most important factors in the improved outcome has been an improvement in the evacuation time,[2] [3] leading to earlier treatments of these injured patients. This signifies the importance of access to early treatment in the management of patients with acute traumatic bleeding. While most large studies assessing treatment methods have been learned from the military, many of these successful methods have been translated into the treatment of civilian traumatic injuries.[1]

Interventional radiology (IR) plays a major role in the evaluation and management of patients suffering traumatic injuries. Advancement in angiography and transcatheter techniques, and the introduction of new embolic agents, has enabled the management of life-threatening bleeding with endovascular embolization, relieving many patients from invasive surgeries and their related morbidity and mortality.[4] With the management preference shifting from surgery to less invasive methods, and particularly with the focus on organ preservation, the role of IR is highly likely to expand even further.[5]

In the setting of acute trauma, the role of IR can be divided into diagnostic angiography, endovascular embolization, visceral diversions, and revascularization procedures. The acute traumatic injuries in which IR is commonly used include bleeding from pelvic trauma, visceral trauma (hepatic, renal, and splenic), and extremity trauma. The authors recently discussed the management of extremity traumas[6]; in this article, a concise review of the basic principles of endovascular embolization in acute pelvic and visceral traumas is presented.

Publication History

Article published online:
15 April 2021

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