1. Feasibility of intraoperative angioembolization for trauma patients using C-arm digital subtraction angiography.
- Author
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Alnumay, Abdulaziz, Caminsky, Natasha, Eustache, Jules Hugo, Valenti, David, Beckett, Andrew Neil, Deckelbaum, Dan, Fata, Paola, Khwaja, Kosar, Razek, Tarek, McKendy, Katherine Marlene, Wong, Evan Gordon, and Grushka, Jeremy Richard
- Subjects
DIGITAL subtraction angiography ,ACADEMIC medical centers ,RADIOEMBOLIZATION ,INTRAOPERATIVE care ,THERAPEUTIC embolization ,PATIENTS ,RETROSPECTIVE studies ,THORACOTOMY ,TREATMENT effectiveness ,EMERGENCY medical services ,CASE studies ,DESCRIPTIVE statistics ,ABDOMINAL surgery ,WOUNDS & injuries ,EVALUATION - 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. [ABSTRACT FROM AUTHOR]- Published
- 2022
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