Abdominal Trauma: Interventional Radiology

  • Germano Scevola
  • Marco Rastelli
  • Giorgio Loreni
  • Claudio Raspanti
  • Gloria Addeo
  • Vittorio Miele
Chapter

Abstract

Over the last decades, as well as diagnostic radiology, interventional radiology techniques have been improved thanks to technological evolution, mostly related to the production of new devices enabling the interventional radiologist to reach anatomical districts not accessible before. As a result of this technological improvement, it was observed an increase of procedures around the world in both vascular and extravascular interventions in terms of numbers and variability, and this was associated with a change in treatment strategies for traumatic patients with the willing of surgeons to prefer, when possible, a Non-Operative Management (NOM).

Non-Operative Management (NOM) can be associated at mini-invasive techniques such as arterial embolization for active bleeding, stent-graft positioning to repair vessels tears and temporary occlusion balloon catheters positioning as a bridge to surgical repair. In the non-operative management, interventional radiology techniques allow a quicker and less invasive treatment if compared with surgery in the management of haemorrhages, especially in blunt abdominal trauma with solid organs injuries and active bleeding suspected on the basis of clinical assessment and confirmed at the Contrast Enhanced Computed Tomography (CECT) study.

Keywords

Trauma Trauma imaging Interventional radiology Non-operative management NOM Angioembolization Computed tomography CT 

References

  1. 1.
    Sclafani SJA. Diagnostic and interventional radiology. In: Mattox KL, Moore EE, Feliciano DV, editors. Trauma. New York: McGrawHill; 2013. p. 251–300.Google Scholar
  2. 2.
    Hoffer EK, Borsa JJ, Bloch RD, et al. Endovascular techniques in the damage control setting. Radiographics. 1999;19:1340–8. doi: 10.1148/radiographics.19.5.g99se051340.CrossRefPubMedGoogle Scholar
  3. 3.
    Chakraverty S, Zealley I, Kessel D. Damage control radiology in the severely injured patient: what the anaesthetist needs to know. Br J Anaesth. 2014;113:250–7. doi: 10.1093/bja/aeu203.CrossRefPubMedGoogle Scholar
  4. 4.
    D’Amours SK, Rastogi P, Ball CG. Utility of simultaneous interventional radiology and operative surgery in a dedicated suite for seriously injured patients. Curr Opin Crit Care. 2013;19:587–93. doi: 10.1097/MCC.0000000000000031.CrossRefPubMedGoogle Scholar
  5. 5.
    Scevola G, Orlacchio A. et al. (2012) Criteria for Clinical, Structural and Technological appropriateness of Interventional Radiology. Quaderni della salute n. 12 – nov 2012. www.quadernidellasalute.it
  6. 6.
    Bozeman MC, Cannon RM, Trombold JM, et al. Use of computed tomography findings and contrast extravasation in predicting the need for embolization with pelvic fractures. Am Surg. 2012;78:825–30.PubMedGoogle Scholar
  7. 7.
    Gourgiotis S, Vougas V, Germanos S, et al. Operative and nonoperative management of blunt hepatic trauma in adults: a single-center report. J Hepato-Biliary-Pancreat Surg. 2007;14:387–391. Epub 2007. doi: 10.1007/s00534-006-1177-2.CrossRefGoogle Scholar
  8. 8.
    Green CS, Bulger EM, Kwan SW. Outcomes and complications of angioembolization for hepatic trauma: a systematic review of the literature. J Trauma Acute Care Surg. 2016;80:529–37. doi: 10.1097/TA.0000000000000942.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Rösch J, Dotter CT, Brown MJ. Selective arterial embolization. A new method for control of acute gastrointestinal bleeding. Radiology. 1972;102:303–6.CrossRefGoogle Scholar
  10. 10.
    Bookstein JJ, Goldstein HM. Successful management of postbiopsy arteriovenous fistula with selective arterial embolization. Radiology. 1973;109:535–6.CrossRefGoogle Scholar
  11. 11.
    Oldham KT, Guice KS, Ryckman F, et al. Blunt liver injury in childhood: evolution of therapy and current perspective. Surgery. 1986;100:542–9.PubMedGoogle Scholar
  12. 12.
    Carrillo EH, Platz A, Miller FB, et al. Non-operative management of blunt hepatic trauma. Br J Surg. 1998;85:461–8.CrossRefGoogle Scholar
  13. 13.
    Velmahos GC, Toutouzas K, Radin R, et al. High success with nonoperative management of blunt hepatic trauma: the liver is a sturdy organ. Arch Surg. 2003;138:475–480.; discussion 480–1. doi: 10.1001/archsurg.138.5.475.CrossRefPubMedGoogle Scholar
  14. 14.
    Monnin V, Sengel C, Thony F, et al. Place of arterial embolization in severe blunt hepatic trauma: a multidisciplinary approach. Cardiovasc Intervent Radiol. 2008;31:875–82. doi: 10.1007/s00270-007-9277-1. Epub 2008 Feb 5CrossRefPubMedGoogle Scholar
  15. 15.
    Stassen NA, Bhullar I, Cheng JD, et al. Nonoperative management of blunt hepatic injury: an eastern Association for the Surgery of trauma practice management guideline. J Trauma Acute Care Surg. 2012;73:288–93. doi: 10.1097/TA.0b013e318270160d.CrossRefGoogle Scholar
  16. 16.
    Gamanagatti S, Rangarajan K, Kumar A, et al. Blunt abdominal trauma: imaging and intervention. Curr Probl Diagn Radiol. 2015;44:321–36. doi: 10.1067/j.cpradiol.2015.02.005.CrossRefPubMedGoogle Scholar
  17. 17.
    Lee YH, Wu CH, Wang LJ, et al. Predictive factors for early failure of transarterial embolization in blunt hepatic injury patients. Clin Radiol. 2014;69:505–11. doi: 10.1016/j.crad.2014.08.013.CrossRefGoogle Scholar
  18. 18.
    Hagiwara A, Murata A, Matsuda T, et al. The efficacy and limitations of transarterial embolization for severe hepatic injury. J Trauma. 2002;52:1091–6.CrossRefGoogle Scholar
  19. 19.
    Tartari S, Montalto C, Ferrante Z, et al. Trauma chiuso addominale: indicazioni al trattamento interventistico. Il Giornale Italiano di. Radiol Med. 2016;3:953–8. doi: 10.17376/girm_3-6-11122016-7.CrossRefGoogle Scholar
  20. 20.
    Dabbs DN, Stein DM, Scalea TM. Major hepatic necrosis: a common complication after angioembolization for treatment of high-grade liver injuries. J Trauma. 2009;66:621–627. discussion 627–9. doi: 10.1097/TA.0b013e31819919f2.CrossRefPubMedGoogle Scholar
  21. 21.
    Kozar RA, Moore JB, Niles SE, et al. Complications of nonoperative management of high-grade blunt hepatic injuries. J Trauma. 2005;59:1066–71.CrossRefGoogle Scholar
  22. 22.
    Bala M, Gazalla SA, Faroja M, et al. Complications of high grade liver injuries: management and outcomewith focus on bile leaks. Scand J Trauma Resusc Emerg Med. 2012;20:20. doi: 10.1186/1757-7241-20-20.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Hsieh CH, Chen RJ, Fang JF, et al. Liver abscess after non-operative management of blunt liver injury. Langenbeck's Arch Surg. 2003;387:343–7. Epub 2002 Dec 12Google Scholar
  24. 24.
    Krige JE, Bornman PC, Terblanche J. Therapeutic perihepatic packing in complex liver trauma. Br J Surg. 1992;79:43–6.CrossRefGoogle Scholar
  25. 25.
    Tinkoff G, Esposito TJ, Reed J, et al. American Association for the Surgery of Trauma organ injury scale I: spleen, liver, and kidney, validation based on the national trauma data bank. J Am Coll Surg. 2008;207:646–55. doi: 10.1016/j.jamcollsurg.2008.06.342. Epub 2008 Aug 30CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Asensio JA, Roldán G, Petrone P, et al. Operative management and outcomes in 103 AAST-OIS grades IV and V complex hepatic injuries: trauma surgeons still need to operate, but angioembolization helps. J Trauma. 2003;54:647–53. discussion 653–4CrossRefGoogle Scholar
  27. 27.
    Gaarder C, Naess PA, Eken T, et al. Liver injuries: improved results with a formal protocol including angiography. Injury. 2007;38:1075–83. Epub 2007 Aug 13CrossRefGoogle Scholar
  28. 28.
    Wahl WL, Ahrns KS, Brandt MM, et al. The need for early angiographic embolization in blunt liver injuries. J Trauma. 2002;52:1097–101.CrossRefGoogle Scholar
  29. 29.
    Carrillo EH, Richardson JD. Delayed surgery and interventional procedures in complex liver injuries. J Trauma. 1999;46:978.CrossRefGoogle Scholar
  30. 30.
    Mohr AM, Lavery RF, Barone A, et al. Angiographic embolization for liver injuries: low mortality, high morbidity. J Trauma. 2003;55:1077–81. discussion 1081–2CrossRefGoogle Scholar
  31. 31.
    Bown MJ, Sutton AJ, Bell PR, Sayers RD. A meta-analysis of 50 years of ruptured abdominal aortic aneurysm repair. Br J Surg. 2002;89:714–30.CrossRefGoogle Scholar
  32. 32.
    De Mestral C, Dueck AD, Gomez D. Associated injuries, management, and outcomes of blunt abdominal aortic injury. J Vasc Surg. 2012;56:656–60. doi: 10.1016/j.jvs.2012.02.027. Epub 2012 Jul 12CrossRefGoogle Scholar
  33. 33.
    Tucker S Jr, Rowe VL, Rao R, et al. Treatment options for traumatic pseudoaneurysms of the paravisceral abdominal aorta. Ann Vasc Surg. 2005;19:613–8. doi: 10.1007/s10016-005-4652-3.CrossRefPubMedGoogle Scholar
  34. 34.
    Yeh MW, Horn JK, Schecter WP, et al. Endovascular repair of an actively hemorrhaging gunshot injury to the abdominal aorta. J Vasc Surg. 2005;42:1007–9. doi: 10.1016/j.jvs.2005.06.007.CrossRefPubMedGoogle Scholar
  35. 35.
    Dajee H, Richardson IW, Iype MO. Seat belt aorta: acute dissection and thrombosis of the abdominal aorta. Surgery. 1979;85:263–7.PubMedGoogle Scholar
  36. 36.
    Starnes BW, Lundgren RS, Gunn M, et al. A new classification scheme for treating blunt aortic injury. J Vasc Surg. 2012;55:47–54. doi: 10.1016/j.jvs.2011.07.073. Epub 2011 Nov 29CrossRefGoogle Scholar
  37. 37.
    Garzón G, Fernández-Velilla M, Martí M et al (2005) Endovascular stent-graft treatment of thoracic aortic disease. Radiographics 1:229–244. DOI:  10.1148/rg.25si055513.CrossRefPubMedGoogle Scholar
  38. 38.
    Kasirajan K, Heffernan D, Langsfeld M. Acute thoracic aortic trauma: a comparison of endoluminal stent grafts with open repair and nonoperative management. Ann Vasc Surg. 2003;17:589–595. Epub Oct 23. doi: 10.1007/s10016-003-0066-2.CrossRefPubMedGoogle Scholar
  39. 39.
    Saratzis NA, Saratzis AN, Melas N, et al. Endovascular repair of traumatic rupture of the thoracic aorta: single-center experience. Cardiovasc Intervent Radiol. 2007;30:370–5.CrossRefGoogle Scholar
  40. 40.
    Watanabe K, Fukuda I, Asari Y. Management of traumatic aortic rupture. Surg Today. 2013;43:1339–46. doi: 10.1007/s00595-012-0471-7. Epub 2013 Jan 23CrossRefPubMedGoogle Scholar
  41. 41.
    Reichart M, Geelkerken RH, Huisman AB, et al. Ruptured abdominal aortic aneurysm: endovascular repair is feasible in 40% of patients. Eur J Vasc Endovasc Surg. 2003;26:479–86.CrossRefGoogle Scholar
  42. 42.
    Alsac JM, Desgranges P, Kobeiter H, Becquemin JP. Emergency endovascular repair for ruptured abdominal aortic aneurysms: feasibility and comparison of early results with conventional open repair. Eur J Vasc Endovasc Surg. 2005;30:632–9. Epub 2005 Aug 1CrossRefGoogle Scholar
  43. 43.
    Resch T, Malina M, Lindblad B, et al. Endovascular repair of ruptured abdominal aortic aneurysms: logistics and short-term results. J Endovasc Ther. 2003;10:440–6. doi: 10.1177/152660280301000307.CrossRefPubMedGoogle Scholar
  44. 44.
    Franks S, Lloyd G, Fishwick G, et al. Endovascular treatment of ruptured and symptomatic abdominal aortic aneurysms. Eur J Vasc Endovasc Surg. 2006;31:345–50. Epub 2006 Jan 24CrossRefGoogle Scholar
  45. 45.
    İslim F, Erbahçeci Salık A, Güven K, et al. Endovascular repair of thoracic and abdominal aortic ruptures: a single-center experience. Diagn Interv Radiol. 2014;20:259–66. doi: 10.5152/dir.2013.13165.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Miele V, Errante Y, Galluzzo M, et al. La diagnostica per immagini nelle lesioni traumatiche della milza. Il Giornale Italiano di. Radiol Med. 2015;2:230–48. doi: 10.17376/girm_2-2-03042015-6.CrossRefGoogle Scholar
  47. 47.
    Federle MP, Crass RA, Brooke Jeffrey R, Trunkey DD. Computed tomography in blunt abdominal trauma. Arch Surg. 1982;117:645–50.CrossRefGoogle Scholar
  48. 48.
    The American Association of Surgery for the Surgery of Trauma. Injury Scoring Scale. Available at http://www.aast.org/Library/TraumaTools/injuryscoringscales.aspx
  49. 49.
    Moore EE, Cogbill TH, Jurkovich GJ, et al. Organ injury scaling; spleen and liver (1994 revision). J Trauma. 1995;38:323–4.CrossRefGoogle Scholar
  50. 50.
    Wiseman J, Brown CV, Weng J, et al. Splenectomy for trauma increases the rate of early postoperative infections. Am Surg. 2006;72:947–50.PubMedGoogle Scholar
  51. 51.
    Gauer JM, Gerber-Paulet S, Seiler C, Scheweizer WP. Twenty years of splenic preservation in trauma: lower early infection rate than in splenectomy. World J Surg. 2008;32:2730–5. doi: 10.1007/s00268-008-9733-3.CrossRefPubMedGoogle Scholar
  52. 52.
    Hann JM, Bochicchio GV, Kramer N, Scalea TM. Non-operative management of blunt splenic injury: a 5-years experience. J Trauma. 2005;58:492–8.CrossRefGoogle Scholar
  53. 53.
    Brasel KJ, DeLisle CM, Olson CJ, Borgstrom DC. Splenic injury: trends in evaluation and management. J Trauma. 1998;44:283–6.CrossRefGoogle Scholar
  54. 54.
    Cogbill TH, Moore EE, Jurkovich GJ, et al. Non-operative management of blunt splenic trauma: a multicenter experience. J Trauma. 1989;29:1312–7.CrossRefGoogle Scholar
  55. 55.
    Velmahos GC, Toutouzas KG, Radin R, Chan L, Demetriades D. Non-operative treatment of blunt injury to solid abdominal organs: a prospective study. Arch Surg. 2003;138:844–51. doi: 10.1001/archsurg.138.8.844.CrossRefPubMedGoogle Scholar
  56. 56.
    Ng EH, Comin J, David E, Pugash R, Annamalai G. Amplatzer vascular plug 4 for proximal splenic artery embolization in blunt trauma. J Vasc Interv Radiol. 2012;23:976–9. doi: 10.1016/j.jvir.2012.04.009.CrossRefPubMedGoogle Scholar
  57. 57.
    Smith HE, Biffl WL, Majercik SD, et al. Splenic artery embolization: have we gone too far? J Trauma. 2006;61:541–544.; discussion 545–6. doi: 10.1097/01.ta.0000235920.92385.2b.CrossRefPubMedGoogle Scholar
  58. 58.
    Schnüriger B, Inaba K, Konstantinidis A, et al. Outcomes of proximal versus distal splenic artery embolization after trauma: a systematic review and meta-analysis. J Trauma. 2011;70:252–60. doi: 10.1097/TA.0b013e3181f2a92e.CrossRefPubMedGoogle Scholar
  59. 59.
    Saour M, Charbit J, Millet I, et al. Effect of renal angioembolization on post-traumatic acute kidney injury after high-grade renal trauma: a comparative study of 52 consecutive cases. Injury. 2014;45:894–901. doi: 10.1016/j.injury.2013.11.030.CrossRefPubMedGoogle Scholar
  60. 60.
    Regine G, Stasolla A, Miele V. Multidetector computed tomography of the renal arteries in vascular emergencies. Eur J Radiol. 2007;64:83–91. doi: 10.1016/j.ejrad.2007.06.007.CrossRefPubMedPubMedCentralGoogle Scholar
  61. 61.
    Dayal M, Gamanagatti S, Kumar A. Imaging in renal trauma. World J Radiol. 2013;5:275–84. doi: 10.4329/wjr.v5.i8.275.CrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    Ramaswamy RS, Darcy MD. Arterial embolization for the treatment of renal masses and traumatic renal injuries. Tech Vasc Interv Radiol. 2016;19:203–10. doi: 10.1053/j.tvir.2016.06.005. Epub 2016 Jun 3CrossRefPubMedGoogle Scholar
  63. 63.
    Sarani B, Powell E, Taddeo J, et al. Contemporary comparison of surgical and interventional arteriography management of blunt renal injury. J Vasc Interv Radiol. 2011;22:723–8. doi: 10.1016/j.jvir.2011.01.444.CrossRefPubMedGoogle Scholar
  64. 64.
    Niola R, Pinto A, Sparano A, et al. Arterial bleeding in pelvic trauma: priorities in angiographic embolization. Curr Probl Diagn Radiol. 2012;41:93–101.CrossRefGoogle Scholar
  65. 65.
    Gansslen A, Giannoudis P, Pape HC. Hemorrhage in pelvic fracture: who needs angiography? Curr Opin Crit Care. 2003;9:515–23.CrossRefGoogle Scholar
  66. 66.
    Heetveld MJ, Harris I, Schlaphoff G, et al. Guidelines for the management of haemodynamically unstable pelvic fracture patients. ANZ J Surg. 2004;74:520–9.CrossRefGoogle Scholar
  67. 67.
    Ierardi AM, Piacentino F, Fontana F, et al. The role of endovascular treatment of pelvic fracture bleeding in emergency settings. Eur Radiol. 2015;25:1854–64.CrossRefGoogle Scholar
  68. 68.
    Pieri S, Agresti P, Morucci M, et al. Percutaneous management of hemorrhages in pelvic fractures. Radiol Med. 2004;107:241–51.PubMedGoogle Scholar
  69. 69.
    Hymel A, Asturias S, Zhao F, et al. Selective vs nonselective embolization vs no embolization in pelvic trauma: a multicenter retrospective cohort study. J Trauma Acute Care Surg. 2017; doi: 10.1097/TA.0000000000001554.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Germano Scevola
    • 1
  • Marco Rastelli
    • 1
  • Giorgio Loreni
    • 1
  • Claudio Raspanti
    • 2
  • Gloria Addeo
    • 3
  • Vittorio Miele
    • 3
  1. 1.Department of Interventional RadiologySandro Pertini HospitalRomeItaly
  2. 2.Department of Interventional RadiologyCareggi University HospitalFlorenceItaly
  3. 3.Department of RadiologyCareggi University HospitalFlorenceItaly

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