Al-Thani Hassan, Abdelrahman Husham, Barah Ali, Asim Mohammad, El-Menyar Ayman
Department of Surgery, Trauma&Vascular Surgery, Hamad General Hospital, Doha, Qatar.
Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar.
Ther Clin Risk Manag. 2021 Apr 19;17:333-343. doi: 10.2147/TCRM.S303518. eCollection 2021.
Massive bleeding is a major preventable cause of early death in trauma. It often requires surgical and/or endovascular intervention. We aimed to describe the utilization of angioembolization in patients with abdominal and pelvic traumatic bleeding at a level 1 trauma center.
We conducted a retrospective analysis for all trauma patients who underwent angioembolization post-traumatic bleeding between January 2012 and April 2018. Patients' data and details of injuries, angiography procedures and outcomes were extracted from the Qatar national trauma registry.
A total of 175 trauma patients underwent angioembolization during the study period (103 for solid organ injury, 51 for pelvic injury and 21 for other injuries). The majority were young males. The main cause of injury was blunt trauma in 95.4% of the patients. The most common indication of angioembolization was evident active bleeding on the initial CT scan (contrast pool or blushes). Blood transfusion was needed in two-third of patients. The hepatic injury cases had higher ISS, higher shock index and more blood transfusion. Absorbable particles (Gelfoam) were the most commonly used embolic material. The overall technical and clinical success rate was 93.7% and 95%, respectively, with low rebleeding and complication rates. The hospital and ICU length of stay were 13 and 6 days, respectively. The median injury to intervention time was 320 min while hospital arrival to intervention time was 274 min. The median follow-up time was 215 days. The overall cohort mortality was 15%.
Angioembolization is an effective intervention to stop bleeding and support nonoperative management for both solid organ injuries and pelvic trauma. It has a high success rate with a careful selection and proper implementation.
大出血是创伤早期死亡的主要可预防原因。通常需要手术和/或血管内介入治疗。我们旨在描述一级创伤中心对腹部和盆腔创伤性出血患者进行血管栓塞术的应用情况。
我们对2012年1月至2018年4月期间因创伤后出血接受血管栓塞术的所有创伤患者进行了回顾性分析。患者数据以及损伤细节、血管造影程序和结果均从卡塔尔国家创伤登记处提取。
在研究期间，共有175例创伤患者接受了血管栓塞术（103例为实体器官损伤，51例为盆腔损伤，21例为其他损伤）。大多数是年轻男性。95.4%的患者损伤主要原因是钝性创伤。血管栓塞术最常见的指征是初次CT扫描时明显的活动性出血（造影剂池或造影剂外渗）。三分之二的患者需要输血。肝损伤病例的损伤严重度评分更高、休克指数更高且输血更多。可吸收微粒（明胶海绵）是最常用的栓塞材料。总体技术成功率和临床成功率分别为93.7%和95%，再出血率和并发症率较低。住院时间和重症监护病房住院时间分别为13天和6天。损伤至干预的中位时间为320分钟，而从医院到达至干预的时间为274分钟。中位随访时间为215天。总体队列死亡率为15%。
血管栓塞术是一种有效的止血干预措施，可支持对实体器官损伤和盆腔创伤的非手术治疗。经过仔细选择和正确实施，其成功率很高。
