Clinical Review

The role of interventional radiology in trauma

BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c497 (Published 08 February 2010) Cite this as: BMJ 2010;340:c497
  1. Ian A Zealley, consultant radiologist,
  2. Sam Chakraverty, consultant radiologist
  1. 1Department of Radiology, Ninewells Hospital and Medical School, Dundee DD1 9SY
  1. Correspondence to: I A Zealley ian.zealley{at}nhs.net

    Summary points

    • Interventional radiological techniques to stop bleeding are a minimally invasive alternative to surgery in blunt abdominal trauma

    • In haemodynamically stable patients with trauma, interventional radiology has an established role in the management of solid organ injuries

    • In haemodynamically unstable patients with trauma, interventional radiology is effective in stemming haemorrhage from pelvic fractures

    • Recent series suggest that in a wider range of haemodynamically unstable patients interventional radiological techniques may further reduce the number of patients needing surgery

    • The overall quality of the evidence for interventional radiological and surgical interventions in trauma is poor

    Most preventable deaths from trauma are caused by unrecognised and therefore untreated haemorrhage, particularly in the abdomen. Haemorrhage causes early deaths, and the associated hypovolaemic shock leads to secondary brain injury and contributes to late death from multiorgan failure.1 Early management is focused on resuscitation and the diagnosis and treatment of life threatening bleeding to prevent the lethal metabolic disturbance triad of acidosis, hypothermia, and coagulopathy.2

    Many aspects of immediate trauma care suffer from a lack of high quality prospective research. This review is based predominantly on evidence from retrospective cohort series and is subject to the limitations inherent in this type of level 2 research.3 There are no prospective randomised controlled trials of interventional radiology in major trauma. Although the volume of level 2 evidence is substantial and contains few contradictory findings, no robust level 1 evidence yet exists. This review aims to summarise the evidence supporting the use of interventional radiological techniques in the management of haemorrhage caused by blunt abdominal trauma.

    What is the role of interventional radiology in abdominal trauma?

    Interventional radiology uses minimally invasive endovascular techniques to stem haemorrhage. Endovascular haemostasic techniques are established in non-trauma clinical scenarios. In trauma, the main application is to control endovascular haemorrhage by blocking bleeding vessels (transcatheter arterial embolisation (fig 1) or relining …

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