Title : Endovascular embolization for the treatment of patients with closed abdominal trauma
Abstract:
Approximately 28-31% of all trauma patients with bleeding have a death. For hemodynamically stable patients with bleeding of closed abdominal trauma, endovascular angiography and embolization is a non-invasive approach that can be used to control bleeding and potentially avoid surgery.
Objective: To analyze the possibility of endovascular embolization in the treatment of patients with closed abdominal trauma
Methods: The N.V. Sklifosovsky Research Institute for Emergency Medicine had 68 patients with closed abdominal trauma between 2022 and 2024. The study included 14 patients, who have endovascular angiography. Mean age of patients was 50±19 years. Time from trauma to hospitalization was 32±47,8 hours. Indication for endovascular angiography was extravasation of contrast agent on computed tomography scan, traumatic hematoma (verified as blood during pincture) and free fluid in abdominal. Endovascular embolization was in Toshiba Infinix VF-I without general anesthesia. It was local anesthetic. For catheterization of visceral arteries used introducers 6Fr for transfemoral and transradial approaches. Merit medical vert 5Fr catheters were placed at the mouth of the damaged artery. When signs of extravasation were detected, microemboli based on PVA 500-710 or COOK embolic coils were selectively introduced through the catheter. Angiographic signs of the absence of extravasation were considered signs of effective hemostasis.
Results: An ultrasound examination of the abdomen revealed: free fluid in the abdominal cavity - 12 patients (85,7%). CT scan with intravenous contrast showed: extravasation of contrast agent – 10 patients (71,4%), free fluid in the abdominal cavity - 12 patients (85,7%), splenic hematoma - 6 patients (42,9%), retroperitoneal hematoma - 6 patients (42,9%), liver hematoma - 2 patients (14,3%). Selective embolization of the splenic artery was in 2 cases (28,5%), renal artery embolization - 2 cases (14,2%), embolization of the lumbar artery - 2 cases (14,2%), hepatic artery embolization - 2 cases (14,2%). We had one cases of recidive blooding (7,1%) and one patient death (7,1%).
Patient with traumatic splenic hematoma (dimensions 28.8 x 12.9 cm) and hairy cell leukemia had recidive blooding. It was third day after selective embolization of the splenic artery. We had image of patient with intraabdominal blooding – according to ultrasonography there is more fluid, decrease in hemoglobin by 30 units, hypotension. After what we needed take patient in operation. We made laparotomy and saw two-stage splenic rupture AAST III. We performed splenectomy, sanitation of the abdominal cavity. The patient was discharged in satisfactory condition. There were no complications of X-ray endovascular interventions.
Conclusions: Selective endovascular embolization is effective in hemodynamically stable patients. It can be perspective direction for patients with blooding and closed abdominal trauma
