Kwon Soonseong, Kim Kyounghwan, Jeong Soon Tak, Kim Joongsuck, Yeo Kwanghee, Kwon Ohsang, Park Sung Jin, Gwak Jihun, Kang Wu Seong
Department of Emergency Medicine, Jeju Regional Trauma Center, Cheju Halla General Hospital, Jeju, Korea.
Department of Trauma Surgery, Jeju Regional Trauma Center, Cheju Halla General Hospital, Jeju, Korea.
J Trauma Inj. 2024 Mar;37(1):28-36. doi: 10.20408/jti.2023.0076. Epub 2024 Jan 12.
Recent advancements in interventional radiology have made angioembolization an invaluable modality in trauma care. Angioembolization is typically performed by interventional radiologists. In this study, we aimed to investigate the safety and efficacy of emergency angioembolization performed by trauma surgeons.
We identified trauma patients who underwent emergency angiography due to significant trauma-related hemorrhage between January 2020 and June 2023 at Jeju Regional Trauma Center. Until May 2022, two dedicated interventional radiologists performed emergency angiography at our center. However, since June 2022, a trauma surgeon with a background and experience in vascular surgery has performed emergency angiography for trauma-related bleeding. The indications for trauma surgeon-performed angiography included significant hemorrhage from liver injury, pelvic injury, splenic injury, or kidney injury. We assessed the angiography results according to the operator of the initial angiographic procedure. The term "failure of the first angioembolization" was defined as rebleeding from any cause, encompassing patients who underwent either re-embolization due to rebleeding or surgery due to rebleeding.
No significant differences were found between the interventional radiologists and the trauma surgeon in terms of re-embolization due to rebleeding, surgery due to rebleeding, or the overall failure rate of the first angioembolization. Mortality and morbidity rates were also similar between the two groups. In a multivariable logistic regression analysis evaluating failure after the first angioembolization, pelvic embolization emerged as the sole significant risk factor (adjusted odds ratio, 3.29; 95% confidence interval, 1.05-10.33; P=0.041). Trauma surgeon-performed angioembolization was not deemed a significant risk factor in the multivariable logistic regression model.
Trauma surgeons, when equipped with the necessary endovascular skills and experience, can safely perform angioembolization. To further improve quality control, an enhanced training curriculum for trauma surgeons is warranted.
介入放射学的最新进展使血管栓塞术成为创伤治疗中一种非常重要的治疗方式。血管栓塞术通常由介入放射科医生实施。在本研究中，我们旨在调查创伤外科医生进行急诊血管栓塞术的安全性和有效性。
我们确定了2020年1月至2023年6月在济州地区创伤中心因严重创伤相关出血而接受急诊血管造影的创伤患者。在2022年5月之前，两名专门的介入放射科医生在我们中心进行急诊血管造影。然而，自2022年6月以来，一名具有血管外科背景和经验的创伤外科医生开始为创伤相关出血进行急诊血管造影。创伤外科医生进行血管造影的指征包括肝损伤、骨盆损伤、脾损伤或肾损伤引起的严重出血。我们根据首次血管造影操作的操作者评估血管造影结果。“首次血管栓塞失败”一词定义为因任何原因再次出血，包括因再次出血接受再次栓塞或因再次出血接受手术的患者。
在因再次出血进行再次栓塞、因再次出血进行手术或首次血管栓塞的总体失败率方面，介入放射科医生和创伤外科医生之间未发现显著差异。两组的死亡率和发病率也相似。在评估首次血管栓塞后失败情况进行的多变量逻辑回归分析中，骨盆栓塞是唯一显著的危险因素（调整后的比值比为3.29；95%置信区间为1.05 - 10.33；P = 0.041）。在多变量逻辑回归模型中，创伤外科医生进行的血管栓塞术不被视为显著危险因素。
当具备必要的血管内技术和经验时，创伤外科医生能够安全地进行血管栓塞术。为进一步提高质量控制，有必要为创伤外科医生加强培训课程。
