Vo Nghia-Jack, Althoen Morgan, Hippe Daniel S, Prabhu Somnath J, Valji Karim, Padia Siddharth A
Department of Radiology and Section of Pediatric Interventional Radiology and Vascular and Interventional Radiology, Seattle Children's Hospital and the University of Washington, Seattle, Washington.
Section of Interventional Radiology, University of Washington, Seattle, Washington; Department of Radiology, University of Washington, Seattle, Washington.
J Vasc Interv Radiol. 2014 Feb;25(2):215-20. doi: 10.1016/j.jvir.2013.09.014. Epub 2013 Nov 16.
Although transcatheter embolization is a well established technique to treat adults in the trauma setting, evidence is lacking in the pediatric population. This study assesses the safety and efficacy of arterial embolization for blunt abdominal and pelvic trauma in the pediatric population.
A retrospective review of abdominal and pelvic angiograms in 97 pediatric patients with blunt trauma was conducted over an 11-year period. Abdominal angiography and embolization was performed for ongoing hepatic, renal, splenic, or nonvisceral retroperitoneal injury. Pelvic angiography was performed in the setting of pelvic fracture with ongoing pelvic hemorrhage. Complications and clinical success rates of these procedures were assessed.
Of the 97 pediatric patients who underwent angiography for acute abdominal or pelvic trauma, 54 (56%) required embolization involving 62 separate sites. Injury severity score greater than 15 was present in 94% of patients. Targets of embolization included the pelvis (n = 39), liver (n = 8), kidney (n = 7), spleen (n = 6), and retroperitoneum (n = 2). Effective hemorrhage control was achieved in 47 patients (87%). Overall mortality rate was 22% (12 of 54), with most deaths related to traumatic brain injury. Five complications occurred in four patients (7%), including three major complications (hepatic abscess, bile leak, and urinary incontinence).
Angiography and embolization is relatively safe and potentially effective in the setting of abdominal and pelvic trauma in the pediatric population. Angiography with embolization should be considered in the treatment algorithm for this patient population.
尽管经导管栓塞术是治疗成人创伤的成熟技术，但儿科人群中缺乏相关证据。本研究评估动脉栓塞术治疗儿科人群钝性腹部和盆腔创伤的安全性和有效性。
对97例钝性创伤儿科患者在11年期间的腹部和盆腔血管造影进行回顾性研究。对持续存在的肝、肾、脾或非内脏腹膜后损伤进行腹部血管造影和栓塞。对伴有持续性盆腔出血的骨盆骨折患者进行盆腔血管造影。评估这些操作的并发症和临床成功率。
在97例因急性腹部或盆腔创伤接受血管造影的儿科患者中，54例（56%）需要栓塞，涉及62个不同部位。94%的患者损伤严重程度评分大于15。栓塞靶点包括骨盆（n = 39）、肝脏（n = 8）、肾脏（n = 7）、脾脏（n = 6）和腹膜后（n = 2）。47例患者（87%）实现了有效的出血控制。总死亡率为22%（54例中的12例），大多数死亡与创伤性脑损伤有关。4例患者（7%）出现5例并发症，包括3例主要并发症（肝脓肿、胆漏和尿失禁）。
血管造影和栓塞术在儿科人群腹部和盆腔创伤中相对安全且可能有效。对于该患者群体的治疗方案应考虑血管造影联合栓塞术。
