Angiographic embolization for intraperitoneal and retroperitoneal injuries

Angiographic embolization (AE) has been used extensively for bleeding contr ol after injuries to the face and neck. Its role in abdominal trauma requir es further exploration. We reviewed the medical records of 137 consecutive patients who underwent angiography with the intent to embolize bleeding sit es within the abdomen. Of them, 97 (71%) had blunt and 40 (29%) had penetra ting trauma. AE was performed for hemorrhage associated with pelvic fractur es (97 patients), Liver lacerations (n = 26), renal lacerations (n = 12), s plenic lacerations (n = 5), other injuries (n = 9), and multiple injuries ( n = 12). On angiography, 102 patients were Found to have bleeding sites and underwent AE, with angiographic and clinical bleeding control in 93 (91%). The rate of successful hemostasis by AE was identical in blunt and penetra ting trauma patients. There was no major morbidity after AE. No factors pre dicted patients with a high likelihood to have a positive angiogram. Patien ts who had AE before or after a period of attempted hemodynamic stabilizati on in the intensive care unit were no different with respect to hemodynamic parameters immediately before AE or effectiveness of AE for bleeding contr ol. AE is a safe and effective method for controlling bleeding after blunt and penetrating intra- and retroperitoneal injuries. Early AE may be used i n selected patients as a front-line therapeutic intervention that offers ex peditious hemostasis and prevents delays in definitive bleeding control.