Indication of Interventional Treatment in Abdominal and Pelvic Trauma

ABSTRACT

PURPOSE: The aim of this study was to evaluate and establish the indications of interventional artery embolization in patients with a traumatic liver, spleen and pelvis injury. METHODS: 91 patients with a traumatic liver, spleen and pelvis injury, who had been treated with interventional arterial embolization from April 1992 to April 2004, were included in this retrospective study. The abdominal pelvic injuries were classified according to the CT scan findings based on the injury scale of the American Association for the Surgery of Trauma. The mechanism of trauma, initial vital signs, initial hemoglobin, hospital length, transfusion amount, shock index and fluid resuscitation amount were surveyed. All the patients underwent angiography. If there was evidence of an active hemorrhage during angiography, interventional arterial embolization with Gelfoam or stainless coil was performed. RESULTS: Among the 91 patients with a traumatic liver, spleen and pelvis injury, 25 out of 30 patients treated by hepatic arterial embolization, 36 out of 42 patients by splenic artery embolization and 14 out of 19 patients by pelvic artery embolization showed successful outcomes that were supported by shock index improvement (P<0.05), less fluid resuscitation requirements (P<0.05) and less packed red blood cell (RBC) requirements (P<0.05). CONCLUSION: Interventional artery embolization is a preferable non-surgical management for patient with a traumatic liver, spleen and pelvis injury. These results suggests that the indications of interventional arterial embolization are a shock index <1, transfusion amount to maintain a Hg level of 10 g/dl <3 pint per day and fluid resuscitation amount <2,000 ml per 2 hours.