Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0375, Kanagawa, Japan.
Eur J Trauma Emerg Surg. 2024 Oct;50(5):2147-2154. doi: 10.1007/s00068-024-02628-2. Epub 2024 Aug 21.
Angiography with carbon dioxide (CO) has long been used as an alternative when iodine contrast media (ICM) cannot be used due to allergy to iodine or renal dysfunction. Conversely, CO angiography is also known as a provocation method for active bleeding. In this study, we examined the efficacy of CO angiography in angioembolization (AE) for trauma patients.
This was a single-center, retrospective, observational study of trauma patients who underwent AE at our facility between January 2012 and April 2023.
Within this period, 335 AEs were performed. CO angiography was performed in 102 patients (30.4%), and in 113 procedures. COangiography was used to provoke active bleeding which went undetected using ICM in 83 procedures, and to confirm hemostasis after embolization in 30 procedures. Of the 80 procedures wherein, active bleeding was not detected on ICM, 35 procedures (43.8%) were detected using CO. The spleen had the highest detection rate of active bleeding by CO angiography among the organs. There were 4/102 (1.9%) patients with CO contrast who underwent some form of reintervention. Two patients were re-embolized with n-butyl-2-cyanoacrylate because of recanalization after embolization with gelatin sponge. The other two patients had pseudoaneurysm formation which required reintervention, and CO angiography was not used. Vomiting was the most common complication of CO angiography in 10 patients (9.8%), whereas all were transient and did not require treatment.
CO angiography of trauma patients may have a better detection rate of active bleeding compared with ICM, leading to reliable hemostasis.
当对碘对比剂（ICM）过敏或肾功能不全时，长期以来一直使用二氧化碳（CO）血管造影作为替代方法。相反，CO 血管造影也被认为是活动性出血的激发方法。在这项研究中，我们检查了 CO 血管造影在创伤患者血管栓塞（AE）中的疗效。
这是一项单中心、回顾性、观察性研究，纳入了 2012 年 1 月至 2023 年 4 月期间在我院接受 AE 的创伤患者。
在此期间，进行了 335 次 AE。在 102 例患者（30.4%）和 113 次手术中进行了 CO 血管造影。COangiography 用于激发使用 ICM 未检测到的活动性出血，在 30 次手术中用于确认栓塞后的止血。在 80 次 ICM 未检测到活动性出血的手术中，35 次手术（43.8%）通过 CO 检测到。CO 血管造影在检测脾脏活动性出血方面的检出率最高。在 102 例 CO 造影患者中，有 4 例（1.9%）患者进行了某种形式的再干预。2 例患者因明胶海绵栓塞后再通而用 n-丁基-2-氰基丙烯酸酯再次栓塞。另外 2 例患者形成假性动脉瘤，需要再次干预，未使用 CO 血管造影。10 例患者（9.8%）出现 CO 血管造影最常见的并发症是呕吐，所有患者均为一过性，无需治疗。
与 ICM 相比，CO 血管造影在创伤患者中可能具有更高的活动性出血检出率，从而实现可靠的止血。
