Angioembolización simultánea de órganos en la estrategia de tratamiento no operatorio en trauma cerrado de abdomen

Sebastian Eduardo Velez

doi:10.31053/1853.0605.v74.n3.14483

Authors

Sebastian Eduardo Velez hospital municipal de urgencias

DOI:

https://doi.org/10.31053/1853.0605.v74.n3.14483

Keywords:

blunt abdominal trauma, angioembolization, nonoperative treatment

Abstract

Background: nonoperative treatment (TNO) is suggested in blunt abdominal trauma in stable patients without necessarily addressing surgical trauma injuries. Among the tools used, it has highlighted the angioembolization as a method of stopping bleeding or potentially bleeding lesions. The existence of more than one lesion may be possible to treat this way. Objectives: to show the experience of a hospital emergency department in the use of angioembolization in nonoperative management of more than one injured abdominal organ. Demonstrate utility of simultaneous angioembolization of more than one vascular territory or organ in the management of patients with blunt abdominal trauma who start a nonoperative treatmeant. Design: Retrospective observational study Methods: Between 2007 and 2014, patients with blunt abdominal trauma and active hemorrhage or potentially bleeding lesions demonstrated by computed tomography (CT) were evaluated. Those who underwent nonoperative treatment and embolized were included. Of these, those with more than one organ or vascular territory embolized were described. Results: 392 patients were admitted with blunt abdominal trauma. Of these, 281 (72 %) started TNO protocol. 225 with active bleeding on CT were found. 183 patients (80 %) underwent angiography and 166 need embolization. In 7 cases embolization of more than one organ or vascular territory was performed. Conclusion: angioembolization of organ with active bleeding is definitely accepted practice in trauma centers. The opportunity and need for more than one organ embolization or vascular territory is scarce, but it is doable when adjusted to existing protocols, respecting especially hemodynamic stability

Downloads

Download data is not yet available.

Author Biography

Sebastian Eduardo Velez, hospital municipal de urgencias

Medico cirujano UNC
Doctor en medicina y cirugia UNC
Profesor universitario en medicina UNC
Especialista en cirugia general CMPC
Especialista en medicina de emergencias CMPC

References

1 Ting-Min Hsieh, Tsung Cheng Tsai, Jiun-Lung Liang y col. Non-operative management attempted for selective high grade blunt hepatosplenic trauma is a feasible strategy. World Journal of Emergency Surgery 2014, 9:51

2 Yanar H, Ertekin C, Taviloglu K, Kabay B, Bakkaloglu H, Guloglu R: Nonoperative treatment of multiple intra-abdominal solid organ injury after blunt abdominal trauma. J Trauma Acute Care Surg 2008, 64(4):943–948.

3 Hagiwara A, Murata A, Matsuda T, et al. (2004) The usefulness of transcatheter arterial embolization for patients with blunt polytrauma showing transient response to fluid resuscitation. J Trauma 57:271–276, discussion 276–277

4 Kortbeek J, Turki S,Advanced Trauma Life Support, 8th Edition, The Evidence for Change. J. Trauma. June 2008. Vol 64-6 (1638-1650).

5 Moore EE, Shackford SR, Pachter HL, et al.Organ injury scaling: spleen, liver, and kidney.J Trauma. 1989 Dec;29(12):1664-6.

6 Tile M Acute Pelvic Fractures: I. Causation and Classification. J Am Acad Orthop Surg. 1996 May;4(3):143-151.

7 Baker SP, O'Neill B, Haddon W, Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974 Mar;14(3):187–196

8 Hoff WS, Holevar M, Nagy KK, Patterson L, Young JS, Practice management guidelines for the evaluation of blunt abdominal trauma: the East practice management guidelines work group. J Trauma. 2002 Sep;53(3):602-15. Review.

9 Stassen NA, Bhullar I, Cheng JD, Crandall ML, Friese RS, Guillamondegui OD, Jawa RS, Maung AA, Rohs TJ Jr, Sangosanya A, Schuster KM, Seamon MJ, Tchorz KM, Zarzuar BL, Kerwin AJ: Eastern Association for the Surgery of Trauma: Nonoperative management of blunt hepatic injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg 2012, 73(5):S288–293.

10 Montenegro RB., Alejandre SE. "Manejo conservador de los traumatismos de abdomen". Relato oficial, 78° Congreso Argentino de Cirugía Asociación Argentina de Cirugía. Publicación extraordinaria. Buenos Aires 2006.

11 Stassen N, Bhullar I, Julius D. Selective nonoperative management of blunt splenic injury: An Eastern Association for the Surgery of Trauma practice management guideline Trauma Acute Care Surg S294 Volume 73, Number 5, Supplement 4 November 2012 - Volume 73 - Issue 5

12 Velmahos GC, Zacharias N, Emhoff TA, Feeney JM, Hurst JM, Crookes BA, Harrington DT, Gregg SC, Brotman S, Burke PA, Davis KA, Gupta R, Winchell RJ, Desjardins S, Alouidor R, Gross RI, Rosenblatt MS, Schulz JT, Chang Y: Management of the most severely injured spleen: a multicenter study of the Research Consortium of New England Centers for Trauma (ReCONECT). Arch Surg 2010, 145(5):456–460

13 Cámara H, Canga C., Marcon G. y Martinez G. Embolizacion arterial en trauma abdominopelviano: impacto en la estabilidad hemodinamica. Rev. HUcba 2007; I (4): 5:11.

14 Lin WC, Chen YF, Lin CH, Emergent transcatheter arterial embolization in hemodynamically unstable patients with blunt splenic injury. Acad Radiol. 2008 Feb;15(2):201-8.

15 Hann JM, Biffl W, Knudson M, et al. Western Trauma Association Multi-Institutional Trials Committee: splenic embolization revisited. J Trauma. 2004; 56: 542–547.

16 Wu SC, et al. Early selective angioembolization improves success of non-operative management of blunt splenic injury. Am Surg. 2007; 73: 897–902.

17 Velmahos GC, Zacharias N, Emhoff TA, et al. Management of the most severely injured spleen.Arch Surg. 2010; 145: 456–460.

18 Davis KA, Fabian TC, Croce MA, et al. Improved success in non-operative management of blunt splenic injuries: embolization of splenic artery pseudoaneurysms. J Trauma. 1998; 44: 1008–1015.

19 Asensio JA, Roldan G, Petrone P, et al. (2003) 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 54:647–653, discussion 653–644

20 Brusa N, Cámera H, Pahnke P, Paulina E, Morales J. Embolizacion arterial en el trauma grave de pelvis: una alternativa terapéutica. Rev. Hucba 2014; IV: 1-6

21 Madoff DC, Denys A, Wallace MJ, y col. Splenic arterial interventions: anatomy, indications, technical considerations, and potential complications. Radiographics. 2005 Oct; 25 Suppl 1:S191-211.

2 Letoublon C1, Morra I, Chen Y, Monnin V, Voirin D, Arvieux C.. Hepatic arterial embolization in the management of blunt hepatic trauma: indications and complicationsJ Trauma. 2011 May;70(5):1032-6.

23 Hann JM, Biffl W, Knudson M, et al. Western Trauma Association Multi-Institutional Trials Committee: splenic embolization revisited. J Trauma. 2004; 56: 542–547.

24 Harbrecht BG, Ko SH, Watson GA, et al. Angiography for blunt splenic trauma does not improve success rate of non-operative management. J Trauma. 2007; 63: 44–49.