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Embolization for pediatric trauma

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Abstract

Background

The management of pediatric trauma with trans-arterial embolization is uncommon, even in level 1 trauma centers; hence, there is a dearth of literature on this subject compared to the adult experience.

Objective

To describe a single-center, level 1 trauma center experience with arterial embolization for pediatric trauma.

Materials and methods

A retrospective review was performed to identify demographics, transfusion requirements, pre-procedure imaging, procedural details, adverse events, and arterial embolization outcomes over a 19-year period. Twenty children (age 4.5 months to 17 years, median 13.5 years; weight 3.6 to 108 kg, median 53 kg) were included. Technical success was defined as angiographic resolution of the bleeding-related abnormality on post-embolization angiography or successful empiric embolization in the absence of an angiographic finding. Clinical success was defined as not requiring additional intervention after embolization.

Results

Seventy-five percent (n=15/20) of patients required red blood cell transfusions prior to embolization with a mean volume replacement 64 ml/kg (range 12–166 ml/kg) and the median time from injury to intervention was 3 days (range 0–16 days). Technical success was achieved in 100% (20/20) of children while clinical success was achieved in 80% (n=16/20). For the 4 children (20%) with continued bleeding following initial embolization, 2 underwent repeat embolization, 1 underwent surgery, and 1 underwent repeat embolization and surgery. Mortality prior to discharge was 15% (n=3). A post-embolization mild adverse event included one groin hematoma, while a severe adverse event included one common iliac artery pseudoaneurysm requiring open surgical ligation.

Conclusions

In this single-center experience, arterial embolization for hemorrhage control in children after trauma is feasible but can be challenging and the clinical failure rate of 20% in this series reflects this complexity. Standardization of pre-embolization trauma assessment parameters and embolic techniques may improve outcomes.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Division of Interventional Radiology, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, USA

    Eric D. Cyphers, Michael R. Acord, Sean Schoeman, Abhay Srinivasan, Seth Vatsky, Ganesh Krishnamurthy, Fernando Escobar, Stephanie Cajigas-Loyola & Anne Marie Cahill

  2. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Michael R. Acord, Michael L. Nance, Abhay Srinivasan, Seth Vatsky, Ganesh Krishnamurthy, Fernando Escobar, Stephanie Cajigas-Loyola & Anne Marie Cahill

  3. Department of Radiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA

    Marian Gaballah

  4. Department of General Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Michael L. Nance

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  1. Eric D. Cyphers
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  2. Michael R. Acord
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Contributions

A.M.C. and M.G. supervised and supported the study. E.C. and M.G. collected and analyzed the data and performed the statistical analysis. E.C., M.G., M.R.A., and A.M.C. drafted and finalized the initial manuscript. M.R.A., S.S., M.L.N., A.S., S.V., G.K., F.E., S.C.L, and S.S. assisted with manuscript revisions. All authors reviewed and approved the final manuscript.

Corresponding author

Correspondence to Eric D. Cyphers.

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Cyphers, E.D., Acord, M.R., Gaballah, M. et al. Embolization for pediatric trauma. Pediatr Radiol 54, 181–196 (2024). https://doi.org/10.1007/s00247-023-05803-6

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  • DOI: https://doi.org/10.1007/s00247-023-05803-6

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