Feasibility of intraoperative angioembolization for trauma patients using C-arm digital subtraction angiography

Abstract

Purpose

Hemodynamically unstable trauma patients who would benefit from angioembolization (AE) typically also require emergent surgery for their injuries. The critical decision of transferring a patient to the operating room versus the interventional radiology (IR) suite can be bypassed with the advent of intra-operative AE (IOAE). Previously limited by the availability of costly rooms termed RAPTOR (resuscitation with angiography, percutaneous techniques and open repair) suites, it has been suggested that using C-arm digital subtraction angiography (DSA) is a comparable alternative. This case series aims to establish the feasibility and safety of IOAE.

Methods

We conducted a retrospective analysis of all trauma patients at our level 1 trauma center who underwent IOAE with a concomitant surgical intervention from January 2011 to May 2019. Descriptive analyses were conducted.

Results

A total of 49 patients (80% male, 44 ± 17 years, 92% blunt) underwent IOAE using the C-arm DSA during the study period. All but one patient underwent exploratory laparotomy, 56% of which underwent an additional surgical procedure (ex. exploratory thoracotomy, orthopedic). Either Gelfoam® (Pfizer, New York, USA) (90%), coils (2.0%), or a combination (8.2%) were used for embolization. Internal iliac embolization was performed in 88% of cases (59% bilateral). IOAE was successful in all but four cases (8.2%) and thirty-day mortality was 31%.

Conclusion

IOAE appears to be a feasible and safe management option in severe trauma patients with the advantage of concurrent operative intervention and ongoing active resuscitation with good success in hemorrhage control.

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Availability of data and materials

Any materials and data that are reasonably requested by others are available from a publicly accessible collection or will be made available in a timely fashion, and in limited quantities to members of the scientific community for non-commercial purposes.

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Acknowledgements

We would like to thank Johanne Prud’homme, medical archivist for the Montreal General Hospital Trauma program, for her help with cleaning and dealing with missing data.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors

Contributions

AA and JRG came up with the study design; AA, NGC and JHE performed data collection; all authors contributed to data analysis and interpretation; AA and NGC drafted the manuscript; all authors contributed to manuscript revision.

Corresponding author

Correspondence to Jeremy Richard Grushka.

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The authors declare that they have no conflict of interest.

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Alnumay, A., Caminsky, N., Eustache, J.H. et al. Feasibility of intraoperative angioembolization for trauma patients using C-arm digital subtraction angiography. Eur J Trauma Emerg Surg (2021). https://doi.org/10.1007/s00068-020-01530-x

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Keywords

  • Intraoperative angioembolization
  • Feasibility
  • Hemorrhage
  • Trauma