Scientific Papers
Angiographic embolization for arrest of bleeding after penetrating trauma to the abdomen

https://doi.org/10.1016/S0002-9610(99)00212-3Get rights and content

Abstract

Background: Angiographic embolization is an effective technique to control bleeding after blunt trauma to the liver or pelvis. Its role in penetrating trauma to the abdomen has not been studied.

Methods: From January 1992 to May 1998, 40 patients underwent angiography for bleeding resulting from intra-abdominal penetrating injuries (33 gunshot wounds, 7 stab wounds). Angiographic embolization of intraperitoneal or retroperitoneal vessels was performed by standard angiographic techniques with gelatin sponge and/or coils. Data were extracted from medical records, radiology data bank, trauma registry, and morbidity/mortality records, and compared by Student’s t test and chi-square test. The main outcome measures were failure of angiographic embolization to control bleeding and complications of angiographic embolization.

Results: Angiography was performed during a course of nonoperative management in 6 patients (group A), because of failure to control bleeding surgically in 23 (group B), and because of late vascular complications after an initially successful operation in 11 more (group C). In 32 patients, angiography revealed active bleeding; 29 (91%) underwent successful angiographic embolization. Of the remaining 3 patients, 2 were successfully managed surgically (1 each from groups A and B) and 1 died despite multiple surgical maneuvers (group B). One patient who developed postoperatively a large, bleeding superior mesenteric artery pseudoaneurysm, suffered extensive bowel necrosis after angiographic embolization. No other significant complication was related to angiographic embolization.

Conclusions: Angiographic embolization after penetrating injuries to the abdomen is safe and effective for a small number of selected patients. It is a valuable tool for bleeding control when surgery has failed. It may be ideal for control of late vascular complications when reoperation is not desirable. It may prove to be a useful adjunct in the nonoperative treatment of selected injuries.

Section snippets

Patients and methods

All patients who underwent angiography for bleeding from intra-abdominal sites after penetrating trauma to the abdomen and back from January 1992 to May 1998 were included. The two body regions were defined by the nipple line and pubic symphysis anteriorly, and the tips of scapulae and gluteal folds posteriorly. Patients with penetrating injuries who had angiography for associated injuries of the extremities or neck, or for reasons not related directly to the anatomical injury (such as stress

Results

During the 77-month study period, 40 patients who were admitted for penetrating trauma to the abdomen and back underwent angiography for bleeding of abdominal or pelvic vessels. The characteristics of these patients are shown in Table I. The vessels embolized are described in Table II.

Group A included 6 patients who had angiography for bleeding as the first line of treatment. Angiography was performed on the basis of hematuria after injuries to the flank in 3, CT scan findings showing hepatic

Comments

To the best of our knowledge, this is the first series reported of patients who underwent angiography with the intent to arrest, by embolization, intra-abdominal bleeding caused by penetrating trauma. Although angiographic embolization has been widely used for blunt trauma,1, 2, 3 the published experience describing its use after penetrating trauma to the torso is limited to a few case reports.11, 12, 13 The belief that most penetrating injuries to the abdomen and back should be treated

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