EMBOLIZATION THERAPY AS AN ALTERNATIVE TO THORACOTOMY IN VASCULAR INJURIES OF THE CHEST-WALL

Hemothorax and persistent thoracic bleeding is frequently an indicatio n for thoracotomy after trauma. Unfortunately, the source of the hemor rhage is often not identified. Presently, selective arteriography and transcatheter embolization (SATE) offers a good and safe alternative t o localize and control hemorrhage from arterial injuries in selected p atients. The records of eight patients who underwent SATE were reviewe d. There were six blunt and two penetrating chest injuries. Four patie nts had significant preexisting medical comorbidities. Three patients with blunt injuries had undergone exploratory thoracotomy, but continu ed to bleed postoperatively. In three patients, angiography was indica ted for associated thoracic and pelvic injuries, and five patients had SATE specifically due to thoracic hemorrhage. In all patients, SATE w as effective to diagnose and control the hemorrhage. There were no com plications related to the SATE procedure. Two patients died secondary to severe cerebral injuries. Given hemodynamic stability, SATE can be considered in patients who have already had a thoracotomy, have signif icant associated medical conditions, or those in need of other angiogr aphic studies. Careful technique and a readiness to abandon SATE in un stable patients or when a suitable catheter position cannot be achieve d are important technical points.