Trauma Unit Department of Surgery, Maasstad Hospital Rotterdam, Rotterdam, the Netherlands.
J Trauma Acute Care Surg. 2012 Nov;73(5):1208-12. doi: 10.1097/TA.0b013e318265ca9f.
Angiography and embolization have become the treatment of choice after abdominal trauma or pelvic injury in hemodynamically stable patients with a suspicion of internal hemorrhage (contrast extravasation, pseudo-aneurysm, or a vessel cutoff diagnosed on computed tomographic scanning). Some studies, however, report a high incidence of rebleeding (failure) or complications. The aim of this study was to evaluate the failure rate and the complications in trauma patients undergoing such procedures.
All consecutive patients (n = 97) admitted to our Level I trauma center between January 2002 and December 2008 in whom angiography with or without embolization was performed were analyzed. Complications were classified as organ specific, puncture site related, and systemic. Additional interventions, required to treat complications, were documented.
The overall failure rate was 12%. Overall, 48 complications were documented in 28 patients. Organ-specific complications were observed in 18 patients (19%), especially abscess formation and infarction of the liver. Puncture site-related complications occurred in three patients. The incidence of contrast-induced nephropathy was 24%. Three patients developed renal failure. Nine of the 15 patients with rebleeding could be managed with reembolization or operative packing, resulting in an organ salvage rate of 93%. Most (83%) of the organ-specific complications and all of the puncture site-related complications could be managed conservatively or with percutaneous treatment.
In the present study, the failure rate and incidence of organ-specific and procedure-related complications were low and often could be managed with nonoperative minimally invasive interventions. Trauma patients undergoing angiography have a high chance (24%) of developing contrast-induced nephropathy and should therefore receive optimal prophylactic measures to avoid this complication.
Therapeutic study, level IV; prognostic/epidemiologic study, level III.
在血流动力学稳定的腹部创伤或骨盆损伤患者中，对于疑似内出血（对比剂外渗、假性动脉瘤或 CT 扫描诊断的血管闭塞），血管造影和栓塞已成为首选治疗方法。然而，一些研究报告称再出血（失败）或并发症的发生率较高。本研究旨在评估接受此类手术的创伤患者的失败率和并发症。
分析了 2002 年 1 月至 2008 年 12 月期间我院 I 级创伤中心连续收治的 97 例接受血管造影术（伴或不伴栓塞术）的患者。将并发症分为器官特异性、穿刺部位相关和系统性。记录了为治疗并发症而进行的其他干预措施。
总体失败率为 12%。共有 28 名患者出现 48 种并发症。18 名患者（19%）出现器官特异性并发症，特别是脓肿形成和肝梗死。3 名患者出现穿刺部位相关并发症。造影剂肾病的发生率为 24%。3 名患者发生肾功能衰竭。15 名再出血患者中有 9 名可通过再次栓塞或手术填塞治疗，器官存活率为 93%。大多数（83%）器官特异性并发症和所有穿刺部位相关并发症均可通过非手术微创干预治疗。
在本研究中，失败率和器官特异性及手术相关并发症的发生率较低，且通常可通过非手术微创干预治疗。接受血管造影术的创伤患者有发生造影剂肾病的高风险（24%），因此应采取最佳预防措施以避免这种并发症。
治疗研究，IV 级；预后/流行病学研究，III 级。
