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36 "Embolization"
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Original Article
Angioembolization performed by trauma surgeons for trauma patients: is it feasible in Korea? A retrospective study
Soonseong Kwon, Kyounghwan Kim, Soon Tak Jeong, Joongsuck Kim, Kwanghee Yeo, Ohsang Kwon, Sung Jin Park, Jihun Gwak, Wu Seong Kang
J Trauma Inj. 2024;37(1):28-36.   Published online January 12, 2024
DOI: https://doi.org/10.20408/jti.2023.0076
  • 792 View
  • 21 Download
AbstractAbstract PDF
Purpose
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.
Methods
We identified trauma patients who underwent emergency angiography due to significant trauma-related hemorrhage between January 2020 and June 2023 at our 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.
Results
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.
Conclusions
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.
Summary
Review Article
Endovascular embolization of persistent liver injuries not responding to conservative management: a narrative review
Simon Roh
J Trauma Inj. 2023;36(3):165-171.   Published online September 15, 2023
DOI: https://doi.org/10.20408/jti.2023.0040
  • 1,372 View
  • 61 Download
AbstractAbstract PDF
Trauma remains a significant healthcare burden, causing over five million yearly fatalities. Notably, the liver is a frequently injured solid organ in abdominal trauma, especially in patients under 40 years. It becomes even more critical given that uncontrolled hemorrhage linked to liver trauma can have mortality rates ranging from 10% to 50%. Liver injuries, mainly resulting from blunt trauma such as motor vehicle accidents, are traditionally classified using the American Association for the Surgery of Trauma grading scale. However, recent developments have introduced the World Society of Emergency Surgery classification, which considers the patient's physiological status. The diagnostic approach often involves multiphase computed tomography (CT). Still, newer methods like split-bolus single-pass CT and contrast-enhanced ultrasound (CEUS) aim to reduce radiation exposure. Concerning management, nonoperative strategies have emerged as the gold standard, especially for hemodynamically stable patients. Incorporating angiography with embolization has also been beneficial, with success rates reported between 80% and 97%. However, it is essential to identify the specific source of bleeding for effective embolization. Given the severity of liver trauma and its potential complications, innovations in diagnostic and therapeutic approaches have been pivotal. While CT remains a primary diagnostic tool, methods like CEUS offer safer alternatives. Moreover, nonoperative management, especially when combined with angiography and embolization, has demonstrated notable success. Still, the healthcare community must remain vigilant to complications and continuously seek improvements in trauma care.
Summary
Case Reports
Successful minimally invasive management using transcatheter arterial embolization in a hemodynamically stable elderly patient with mesenteric vascular injury in a hybrid emergency room system in Korea: a case report
So Ra Ahn, Joo Hyun Lee, Sang Hyun Seo, Chan Yong Park
J Trauma Inj. 2023;36(4):435-440.   Published online July 25, 2023
DOI: https://doi.org/10.20408/jti.2023.0018
  • 2,211 View
  • 22 Download
AbstractAbstract PDF
Mesenteric injury occurs rarely in cases associated with blunt abdominal trauma. Despite its low incidence, mesenteric injury can lead to fatal outcomes such as hypovolemic shock due to hemoperitoneum or sepsis due to intestinal ischemia, or perforation-related peritonitis. For mesenteric injuries, especially those involving massive bleeding, intestinal ischemia, and perforation, the standard treatment is surgery. However, in the case of operative management, it should be borne in mind that there is a possibility of complications and mortality during and after surgery. The usefulness of transcatheter arterial embolization (TAE) is well known in solid organs but is controversial for mesenteric injury. We present a 75-year-old man with mesenteric injury due to blunt abdominal trauma. Initial abdominal computed tomography showed no hemoperitoneum, but a mesenteric contusion and pseudoaneurysm with a diameter of 17 mm were observed near the origin of the superior mesenteric artery. Since there were no findings requiring emergency surgery such as free air or intestinal ischemia, it was decided to perform nonoperative management with TAE using microcoils in hybrid emergency room system. TAE was performed successfully, and there were no complications such as bleeding, bowel ischemia, or delayed bowel perforation. He was discharged on the 23rd day after admission with percutaneous catheter drainage for drainage of mesenteric hematoma. The authors believe that treatment with TAE for highly selected elderly patients with mesenteric injuries has the positive aspect of minimally invasive management, considering the burden of general anesthesia and the various avoidable intraoperative and postoperative complications.
Summary
Gastric necrosis after gastric artery embolization in a patient with blunt abdominal trauma: a case report
Gil Hwan Kim, Sung Jin Park, Chan Ik Park
J Trauma Inj. 2022;35(4):287-290.   Published online December 20, 2022
DOI: https://doi.org/10.20408/jti.2022.0054
  • 1,363 View
  • 34 Download
AbstractAbstract PDF
Gastric artery bleeding after blunt trauma is rare. In such cases, if vital signs are stable, angiographic embolization may be performed. Although gastric artery embolization is known to be safe due to its anatomical properties, complications may occur. We report a case of gastric necrosis after gastric artery embolization in a patient with blunt abdominal trauma. The 55-year-old male patient was found with gastric arterial bleeding after a traffic accident. His vital signs were stable, and gastric artery embolization was performed. Gastric necrosis was subsequently found, which was treated surgically.
Summary
Exercise-induced traumatic muscle injuries with active bleeding successfully treated by embolization: three case reports
Yoonjung Heo, Hye Lim Kang, Dong Hun Kim
J Trauma Inj. 2022;35(3):219-222.   Published online September 28, 2022
DOI: https://doi.org/10.20408/jti.2022.0028
  • 1,676 View
  • 44 Download
  • 1 Citations
AbstractAbstract PDF
Muscle injuries caused by indirect trauma during exercise are common. Most of these injuries can be managed conservatively; however, further treatment is required in extreme cases. Although transcatheter arterial embolization is a possible treatment modality, its role in traumatic muscle injuries remains unclear. In this case series, we present three cases of exercise-induced muscle hemorrhage treated by transcatheter arterial embolization with successful outcomes. The damaged muscles were the rectus abdominis, adductor longus, and iliopsoas, and the vascular injuries were accessed via the femoral artery during the procedures.
Summary

Citations

Citations to this article as recorded by  
  • Thermal and Magnetic Dual-Responsive Catheter-Assisted Shape Memory Microrobots for Multistage Vascular Embolization
    Qianbi Peng, Shu Wang, Jianguo Han, Chenyang Huang, Hengyuan Yu, Dong Li, Ming Qiu, Si Cheng, Chong Wu, Mingxue Cai, Shixiong Fu, Binghan Chen, Xinyu Wu, Shiwei Du, Tiantian Xu
    Research.2024;[Epub]     CrossRef
Salvation of a solitary kidney in a patient with grade IV renal trauma: a case report
Hyuntack Shin, Ae Jin Sung, Min A Lee, Jayun Cho, Gil Jae Lee, Byungchul Yu, Kang Kook Choi
J Trauma Inj. 2022;35(Suppl 1):S18-S22.   Published online June 17, 2022
DOI: https://doi.org/10.20408/jti.2021.0091
  • 1,738 View
  • 49 Download
AbstractAbstract PDF
There are many reasons for solitary kidney. Congenital causes include renal agenesis and dysplasia. Acquired causes include nephrectomy performed for reasons including traumatic kidney injury, disease (e.g., renal cell carcinoma), and donation for kidney transplantation. According to the European Association of Urology, the World Society of Emergency Surgery, and the American Association for the Surgery of Trauma guidelines, it is important to preserve the remaining renal function as much as possible when a solitary kidney patient has suffered a traumatic kidney injury. The authors present a case of kidney preservation in a solitary kidney patient with a traumatic grade IV renal injury through non-operative management involving superselective renal artery angioembolization.
Summary
Endovascular treatment of penetrating nail gun injury of the cervical spine and vertebral artery: a case report
Alexei Christodoulides, Scott Mitchell, Bradley N. Bohnstedt
J Trauma Inj. 2022;35(3):223-227.   Published online May 26, 2022
DOI: https://doi.org/10.20408/jti.2021.0082
  • 1,849 View
  • 70 Download
AbstractAbstract PDF
In this report, we present a case of high cervical penetrating trauma with vertebral artery injury and outline preprocedural, procedural, and postprocedural considerations with recommendations for the treatment of similar injuries. Management involves multiple imaging modalities, including X-ray imaging, computed tomography, computed tomography angiography, magnetic resonance imaging, and catheter angiography. We recommend endovascular treatment of these injuries when possible, based on the improved ability to achieve proximal and distal control and manage hemorrhage risk.
Summary
Portal vein embolization in intrahepatic portal vein injury after blunt trauma: a case report
Sung Hoon Cho, Sang Yub Lee, Jung Geun Cha, Jihoon Hong, Sangcjeol Lee, Kyoung Hoon Lim
J Trauma Inj. 2022;35(Suppl 1):S31-S34.   Published online May 19, 2022
DOI: https://doi.org/10.20408/jti.2022.0013
  • 2,474 View
  • 56 Download
  • 1 Citations
AbstractAbstract PDF
Mortality from hepatic injury has declined over the last several decades for various reasons, including nonoperative management, such as angioembolization, in more than 80% of cases. Conversely, surgical treatment is preferred in intrahepatic portal vein injury due to several reasons. Here, we report a case that treatment of blunt traumatic liver injury accompanied by intrahepatic portal vein injury through portal vein embolization. A 29-year-old female patient was transferred to our trauma center for vehicular accident injuries. Contrast-enhanced abdominal computed tomography showed a massive hemoperitoneum and liver laceration (grade IV) with contrast extravasation suspected of the right portal vein branch but no other organ injury. Since vital signs were stable, we decided to perform nonsurgical radiologic intervention. Portography showed active bleeding of the posterior branch of the right portal vein. A pseudoaneurysm in the portal vein was embolized through percutaneous transhepatic portal vein puncture. On follow-up liver dynamic computed tomography performed 2 days after embolization, the posterior branch of the right portal vein was sufficiently embolized, and no liver parenchymal necrosis was observed. The patient was discharged without any complications 2 weeks later. This report suggests portal vein embolization as a good alternative treatment method for portal vein injury in patients with stable vital signs.
Summary

Citations

Citations to this article as recorded by  
  • Portal vein embolization following arterial portography for the management of an active portal bleeding after blunt liver trauma in a cirrhotic patient
    Romain L’Huillier, Bénédicte Cayot, Jean Turc, Laurent Milot
    CVIR Endovascular.2024;[Epub]     CrossRef
Non-Operative Management with Angioembolization of Grade IV and V Renal Injuries in a Hybrid Emergency Room System
So Ra Ahn, Sang Hyun Seo, Joo Hyun Lee, Chan Yong Park
J Trauma Inj. 2021;34(3):191-197.   Published online September 30, 2021
DOI: https://doi.org/10.20408/jti.2021.0034
  • 3,327 View
  • 85 Download
  • 1 Citations
AbstractAbstract PDF

Renal injuries occur in more than 10% of patients who sustain blunt abdominal injuries. Non-operative management (NOM) is the established treatment strategy for lowgrade (I–III) renal injuries. However, despite some evidence that NOM can be successfully applied to high-grade (IV, V) renal injuries, it remains unclear whether NOM is appropriate in such cases. The authors report two cases of high-grade renal injuries that underwent NOM after embolization in a hybrid emergency room (ER) system with a 24/7 in-house interventional radiology (IR) team. A 29-year-old male visited Wonkwang University Hospital Regional Trauma Center complaining of right abdominal pain after being hit by a rope. Computed tomography (CT) was performed 16 minutes after arrival, and the CT scan indicated a grade V right renal injury. Arterial embolization was initiated within 31 minutes of presentation. A 56-year-old male was transferred to Wonkwang University Hospital Regional Trauma Center with a complaint of right flank pain. He had initially presented to a nearby hospital after falling from a 3-m height. Thanks to the key CT images sent from the previous hospital prior to the patient’s arrival, angiography was performed within 8 minutes of the patient’s arrival and arterial embolization was completed within 25 minutes. Both patients were treated successfully through NOM with angioembolization and preserved kidneys. Hematoma in the first patient and urinoma in the second patient resolved with percutaneous catheter drainage. The authors believe that the hybrid ER system with an in-house IR team could contribute to NOM and kidney preservation even in high-grade renal injuries.

Summary

Citations

Citations to this article as recorded by  
  • Endovascular embolization of persistent liver injuries not responding to conservative management: a narrative review
    Simon Roh
    Journal of Trauma and Injury.2023; 36(3): 165.     CrossRef
Non-Permanent Transcatheter Proximal Renal Artery Embolization for a Grade 5 Renal Injury with Delayed Recanalization and Preserved Renal Parenchymal Enhancement
Abhishek Jairam, Bradley King, Zachary Berman, Gerant Rivera-Sanfeliz
J Trauma Inj. 2021;34(3):198-202.   Published online September 30, 2021
DOI: https://doi.org/10.20408/jti.2020.0075
  • 2,898 View
  • 66 Download
  • 2 Citations
AbstractAbstract PDF

Super-selective renal artery embolization is an increasingly popular technique for the management of traumatic, low-grade renal trauma. When performed in distal arterial branches, this intervention enables tissue preservation and arrest of hemorrhage, but it may not be practical in cases of multifocal, high-grade renal injuries. In such cases, surgical nephrectomy remains the more common treatment modality to ensure hemodynamic control. We present the unique case of a patient who presented in hemorrhagic shock following a major trauma that resulted in a grade 5 renal injury treated with complete renal artery embolization using Gelfoam, resulting in hemodynamic stabilization. Interestingly, imaging 1 month after embolization revealed residual enhancement of the inferior pole of the kidney, suggesting reconstitution of flow and partial renal salvage. Ultimately, transcatheter “nephrectomy” with careful selection of a temporary embolic agent may serve as a safe and efficient alternative to surgical nephrectomy with the added possibility of preserving partial renal perfusion and function in the emergent setting.

Summary

Citations

Citations to this article as recorded by  
  • Salvation of a solitary kidney in a patient with grade IV renal trauma: a case report
    Hyuntack Shin, Ae Jin Sung, Min A Lee, Jayun Cho, Gil Jae Lee, Byungchul Yu, Kang Kook Choi
    Journal of Trauma and Injury.2022; 35(Suppl 1): S18.     CrossRef
  • The Role of Renal Artery Embolisation in the Management of Blunt Renal Injuries: A Review
    Rosemary Denning Ho, Vivek Shrivastava, Amir Mokhtari, Raghuram Lakshminarayan
    Vascular and Endovascular Review.2022;[Epub]     CrossRef
Non-Operative Management of Traumatic Gallbladder Bleeding with Cystic Artery Injury: A Case Report
Tae Hoon Kim
J Trauma Inj. 2021;34(3):208-211.   Published online August 19, 2021
DOI: https://doi.org/10.20408/jti.2021.0003
  • 2,787 View
  • 67 Download
AbstractAbstract PDF

Gallbladder injuries are rare in cases of blunt abdominal trauma and are usually associated with damage to other internal organs. If the physician does not suspect gallbladder injury and check imaging studies carefully, it may be difficult to distinguish a gallbladder injury from gallbladder stone, hematoma, or bleeding. Therefore, in order not to miss the diagnosis, the clinical findings and correlation should be confirmed. In the present case, a 60-year-old male presented to a local trauma center complaining of pain in the upper right quadrant and chest wall following a motor vehicle collision. Abdominal computed tomography (CT) showed a hepatic laceration and hematoma in the parenchyma in segments 4, 5, and 6 and active bleeding in the lumen of the gallbladder. Traumatic gallbladder injuries generally require surgery, but in this case, non-operative management was possible with cautious follow-up consisting of abdominal CT and angiography with repeated physical examinations and hemodynamic monitoring in the intensive care unit.

Summary
Splenic Artery Bleeding into the Extraperitoneal Space Mimicking Mesenteric Injury: A Rare Case of Blunt Trauma
Sang Hyun Seo, Hyun Seok Jung, Chan Yong Park
J Trauma Inj. 2021;34(2):141-145.   Published online March 15, 2021
DOI: https://doi.org/10.20408/jti.2020.0076
  • 2,932 View
  • 102 Download
AbstractAbstract PDF

Splenic injury is a common result of blunt trauma, and bleeding occurs mainly inside the splenic capsule and may leak into the peritoneal space. Herein, we report a case where active bleeding occurred in the splenic artery and only leaked into the extraperitoneal space. This is the first case of this phenomenon in a trauma patient in the English-language literature. Bleeding passed through the peritoneum, leaked into the anterior pararenal space, and continued along the extraperitoneal space to the prevesical space of the pelvis. Therefore, on the initial computed tomography (CT) scan, the bleeding appeared to be in the left paracolic gutter, so we suspected mesenteric bleeding. However, after the CT series was fully reconstructed, we accurately read the scans and confirmed splenic injury with active bleeding. If there had been a suspicion of bowel or mesenteric injury, surgery would have been required, but fortunately surgery could be avoided in this case. The patient was successfully treated with angioembolization.

Summary
Hemorrhagic Shock in a Patient with a Morel-Lavallée Lesion Combined with Active Arterial Bleeding without Fracture
Eic Ju Lim, Jong-Keon Oh, Jae-Woo Cho, Seungyeob Sakong, Jun-Min Cho
J Trauma Inj. 2021;34(1):61-65.   Published online November 30, 2020
DOI: https://doi.org/10.20408/jti.2020.0013
  • 3,618 View
  • 93 Download
AbstractAbstract PDF

A Morel-Lavallée lesion is a closed degloving injury caused by traumatic separation of the skin and subcutaneous tissue from the underlying fascia. However, since physicians tend to focus on treating the bone fracture, hemodynamic instability accompanying a Morel-Lavallée lesion can sometimes be overlooked. We report the case of a hemodynamically unstable 73-year-old man who had a Morel-Lavallée lesion of the thigh, but no femur fracture. Angiography showed active bleeding from the muscular branch of the right deep femoral artery, which was then successfully embolized.

Summary
Original Article
Essential Factors in Predicting the Need for Angio-Embolization in the Acute Treatment of Pelvic Fracture with Hemorrhage
Seok-Won Yang, Hee-Gon Park, Sung-Hyun Kim, Sung-Hyun Yoon, Seung-Gwan Park
J Trauma Inj. 2019;32(2):101-106.   Published online June 30, 2019
DOI: https://doi.org/10.20408/jti.2019.008
  • 3,262 View
  • 51 Download
AbstractAbstract PDF
Purpose

The purpose of this study was to determine the essential factors for prompt arrangement of angio-embolization in patients with pelvic ring fractures.

Methods

A total of 62 patients with pelvic ring fractures who underwent angio-embolization in Dankook University Hospital from March 2013 to June 2018 were retrospectively reviewed. There were 38 men and 24 women with a mean age of 59.8 years. The types of pelvic ring fractures were categorized according to the Tile classification. Patient variables included sex, initial hemoglobin concentration, initial systolic blood pressure, transfused packed red blood cells within 24 hours, Injury Severity Score (ISS), mortality rate, length of hospital stay, and time to angio-embolization.

Results

The most common pelvic fracture pattern was Tile type B (n=34, 54.8%). The mean ISS was 27.3±10.9 with 50% having an ISS ≥25. The mean time to angio-embolization from arrival was 173.6±89 minutes. Type B (180.1±72.3 minutes) and type C fractures (174.7±91.3 minutes) required more time to angio-embolization than type A fractures (156.6±123 minutes). True arterial bleeding was identified in types A (35.7%), B (64.7%), and C (71.4%).

Conclusions

It is important to save time to reach the angio-embolization room in treating patients with pelvic bone fractures. Trauma surgeons need to consider prompt arrangement of angio-embolization when encountering Tile type B or C pelvic fractures due to the high risk of true arterial bleeding.

Summary
Case Report
Minimally Invasive Stabilization with Percutaneous Screws Fixation of APC-3 Pelvic Ring Injury
Beom-Soo Kim, Jong-Keon Oh, Jae-Woo Cho, Do-Hyun Yeo, Jun-Min Cho
J Trauma Inj. 2019;32(1):60-65.   Published online March 31, 2019
DOI: https://doi.org/10.20408/jti.2018.015
  • 6,026 View
  • 123 Download
AbstractAbstract PDF

Pelvic fractures are associated with life-threatening injuries and high rates of morbidity and mortality. Management of internal blood loss associated with unstable pelvic ring injuries is paramount during the initial period. The reconstruction of the pelvic ring is of importance because it is a major contributor to the stability of the pelvic ring. We report the case of a 25-year-old man who had an unstable pelvic ring fracture combined with rupture of an obturator artery and had a successful and satisfactory treatment using minimally invasive surgery with percutaneous antegrade screw fixation.

Summary

J Trauma Inj : Journal of Trauma and Injury