Trauma and Critical Care Center, Division of General Surgery, Department of Surgery, Chang-Gung Memorial Hospital, Chang-Gung University, Linkou, Taiwan.
Scand J Trauma Resusc Emerg Med. 2012 Jul 7;20:46. doi: 10.1186/1757-7241-20-46.
Catheter angiography is often arranged when vascular contrast extravasations on computed tomography (VCEC) presents after blunt torso trauma. However, catheter angiograph can be negative for bleeding and further management about this condition is not well discussed. The purpose of this study was a review of our experience of this discrepancy and to propose management principle.
We conducted a retrospective analysis of patients who received catheter angiography due to VCEC after blunt torso trauma at a level one trauma center in Taiwan from January 1, 2006 to December 31, 2009. Patient data abstracted included demographic data, injury mechanism, Injury Severity Score, vital signs and laboratory data obtained in the emergency department, CT and angiography results, embolization status, rebleeding and outcome. Analysis was performed according to angiographic results, VCEC sites, and embolization status.
During the study period, 182 patients received catheter angiography due to VCEC, and 48 (26.4%) patients had negative angiography. The kidney had the highest incidence (31.7%) for a discrepant result. Non-selective proximal embolization under negative angiography was performed mostly in pelvic fracture and spleen injury. Successful treatment without embolization after negative angiography was seen in the liver, kidney and pelvic fractures. However, some rebleeding happened in pelvic fractures with VCEC even after embolization on negative angiography.
A negative catheter angiography after VCEC is possible in blunt torso trauma, and this occurs most in kidney. Embolization or not under this discrepancy requires an integrated consideration of injury site, clinical presentations, and the risk of rebleeding. Liver and kidney in blunt torso trauma can be managed successfully without embolization when catheter angiography is negative for bleeding after VCEC.
在钝性躯干创伤后出现计算机断层扫描（CT）血管造影剂外渗（VCEC）时，通常会安排导管血管造影。然而，导管血管造影可能显示无出血，并且对于这种情况的进一步处理尚未得到很好的讨论。本研究的目的是回顾我们在台湾一家一级创伤中心对因钝性躯干创伤后 VCEC 而行导管血管造影的患者的经验，并提出处理原则。
我们对 2006 年 1 月 1 日至 2009 年 12 月 31 日在台湾一家一级创伤中心因钝性躯干创伤后 VCEC 而行导管血管造影的患者进行了回顾性分析。提取的患者数据包括人口统计学数据、损伤机制、损伤严重程度评分、急诊时的生命体征和实验室数据、CT 和血管造影结果、栓塞状态、再出血和结局。根据血管造影结果、VCEC 部位和栓塞状态进行分析。
在研究期间，182 例患者因 VCEC 而行导管血管造影，其中 48 例（26.4%）患者的血管造影结果为阴性。肾脏的差异结果发生率最高（31.7%）。在阴性血管造影下进行非选择性近端栓塞主要见于骨盆骨折和脾损伤。在阴性血管造影下，在肝脏、肾脏和骨盆骨折成功治疗后无需栓塞。然而，一些骨盆骨折在阴性血管造影后即使进行了栓塞也发生再出血。
在钝性躯干创伤后，VCEC 后出现阴性导管血管造影是可能的，这种情况在肾脏中最常见。在这种情况下，是否进行栓塞需要综合考虑损伤部位、临床表现和再出血风险。在钝性躯干创伤后，当 VCEC 后导管血管造影显示无出血时，肝脏和肾脏可以成功地无需栓塞进行治疗。
