Angiographic Evaluation and Intervention for Traumatic Solid Organ Injuries
VBMC TRAUMA CARE SERVICES GUIDELINE
TITLE: Angiographic Evaluation and Intervention for
Traumatic Solid Organ Injuries
PURPOSE:
Over the past twenty years there has been a shift towards
non-operative management (NOM) for hemodynamically stable patients with
abdominal trauma. Angiographic embolization can achieve hemostasis and salvage
organs without the morbidity of surgery, and the development and refinement of
embolization techniques has widened the
indications for NOM in the management of solid organ injury.
These improvements mean that whilst surgery is still usually recommended for
patients with penetrating injuries, multiple bleeding sites or hemodynamic
instability, the indications for NOM and angiographic evaluation and
embolization are expanding.
GUIDELINE:
Patients who are hemodynamically unstable or who have diffuse peritonitis after blunt abdominal trauma should be taken urgently for laparotomy.
In the hemodynamically stable blunt abdominal trauma patient without peritonitis, an abdominal CT scan with intravenous contrast should be performed.
Solid Organ Injuries should be graded according to the AAST
solid organ injury Grading Scale:
Angiography with embolization may be considered as a
first-line intervention for a patient who is a transient responder to
resuscitation as an adjunct to potential operative intervention in patients
with Grade III or greater solid organ injuries.
Angiography with embolization should be considered in a
hemodynamically stable patient with evidence of active extravasation (a
contrast blush) on abdominal CT scan.
RESOURCES/REFERENCES: