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Endovascular Therapy in Trauma

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The Shock Trauma Manual of Operative Techniques

Abstract

The use of interventional procedures in trauma has increased steadily over the past 10 years. An analysis of the National Trauma Data Bank (NTDB) reported that 8.1 % of acute arterial injuries in 2003 were treated with endovascular therapy, compared to only 2.1 % in 1994. Nearly an equal number of blunt (55 %) and penetrating (45 %) injuries were treated with endovascular therapy. A more recent study, also using NTDB data, reported that 16 % of traumatic vascular injuries were treated with endovascular therapy, including 20 % who were hypotensive at the time of intervention. Endovascular therapy in trauma involves a minimally invasive, catheter-based approach. Sheaths, catheters, and guidewires are universal instruments, regardless of procedure. Devices passed over guidewires form the basis of diagnosis and treatment.

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References

  1. Reuben BC, Whitten MG, Sarfati M, Kraiss LW. Increasing use of endovascular therapy in acute arterial injuries: analysis of the National Trauma Data Bank. J Vasc Surg. 2007;46(6):1222–6.

    Article  PubMed  Google Scholar 

  2. Avery LE, Stahlfeld KR, Corcos AC, Scifres AM, Ziembicki JA, Varcelotti J, Peitzman AB, Billiar TR, Sperry JL. Evolving role of endovascular techniques for traumatic vascular injury: a changing landscape? J Trauma Acute Care Surg. 2012;72(1):41–6. discussion 46–7.

    PubMed  Google Scholar 

  3. Demetriades D, Velmahos G, Scalea TM, et al. Operative repair or endovascular stent graft in blunt traumatic thoracic aortic injuries: results of an American Association for the Surgery of Trauma multicenter study. J Trauma. 2008;64:561–70. discussion 570–1.

    Article  PubMed  Google Scholar 

  4. Nicholls S, Karmy-Jones R. Ten-year follow-up after endovascular repair of traumatic abdominal aortic rupture. Innovations. 2011;6(1):51–3.

    PubMed  Google Scholar 

  5. Dake M, White R, Diethrich EB, et al. Report on endograft management of traumatic thoracic aortic transections at 30 days and 1 year from a multidisciplinary subcommittee of the SVS. J Vasc Surg. 2011;53(4):1091–6.

    Article  PubMed  Google Scholar 

  6. Dajee H, Richardson IW, Iype MO. Seat belt aorta: acute dissection and thrombosis of the abdominal aorta. Surgery. 1979;85:263–7.

    CAS  PubMed  Google Scholar 

  7. Bergqvist D, Takolander R. Aortic occlusion following blunt trauma of the abdomen. J Trauma. 1981;21(4):319–22.

    Article  CAS  PubMed  Google Scholar 

  8. Brunsting LA, Ouriel K. Traumatic fracture of the abdominal aorta. Rupture of a calcified abdominal aorta with minimal trauma. J Vasc Surg. 1988;8(2):184–6.

    Article  CAS  PubMed  Google Scholar 

  9. Malhotra AK, Fabian TC, Croce MA, Weiman DS, Gavant ML, Pate JW. Minimal aortic injury: a lesion associated with advancing diagnostic techniques. J Trauma. 2001;51:1042–8.

    Article  CAS  PubMed  Google Scholar 

  10. Meghoo CA, Gonzalez EA, Tyroch AH, Wohltmann CD. Complete occlusion after blunt injury to the abdominal aorta. J Trauma. 2003;55(4):795–9.

    Article  PubMed  Google Scholar 

  11. Berthet JP, Marty-Ane CH, Veerapen R, Picard E, Mary H, Alric P. Dissection of the abdominal aorta in blunt trauma: endovascular or conventional surgical management? J Vasc Surg. 2003;38(5):997–1003.

    Article  PubMed  Google Scholar 

  12. Halkos ME, Nicholas J, Kong LS, Burke JR, Milner R. Endovascular management of blunt abdominal aortic injury. Vascular. 2006;14(4):223–6.

    Article  PubMed  Google Scholar 

  13. Reisman JD, Morgan AS. Analysis of 46 intra-abdominal aortic injuries from blunt trauma: case reports and literature review. J Trauma. 1990;30(10):1294–7.

    Article  CAS  PubMed  Google Scholar 

  14. Shalhub S, Starnes BW, Tran NT, Hatsukami TS, Lundgren RS, Davis CW, et al. Blunt abdominal aortic injury. J Vasc Surg. 2012;55(5):1277–85.

    Article  PubMed  Google Scholar 

  15. Azizzadeh A, Keyhani K, Miller III CC, Coogan SM, Safi HJ, Estrera AL. Blunt traumatic aortic injury: initial experience with endovascular repair. J Vasc Surg. 2009;49(6):1403–8.

    Article  PubMed  Google Scholar 

  16. Deree J, Shenvi E, Fortlage D, et al. Patient factors and operating room resuscitation predict mortality in traumatic abdominal aortic injury: a 20-year analysis. J Vasc Surg. 2007;45:493–7.

    Article  PubMed  Google Scholar 

  17. Goaley TJ, Dente CJ, Feliciano DV. Torso vascular trauma at an urban level I trauma center. Perspect Vasc Surg Endovasc Ther. 2006;18(2):102–12.

    Article  PubMed  Google Scholar 

  18. de Mestral C, Dueck AD, Gomez D, Haas B, Nathens AB. Associated injuries, management, and outcomes of blunt abdominal aortic injury. J Vasc Surg. 2012;56(3):656–60.

    Article  PubMed  Google Scholar 

  19. Aladham F, Sundaram B, Williams DM, Quint LE. Traumatic aortic injury: computerized tomographic findings at presentation and after conservative therapy. J Comput Assist Tomogr. 2010;34(3):388–94.

    Article  PubMed  Google Scholar 

  20. Willis M, Neschis D, Menaker J, Lilly M, Scalea T. Stent grafting for a distal thoracic aortic injury. Vasc Endovascular Surg. 2011;45(2):187–90.

    Article  PubMed  Google Scholar 

  21. Burkhart HM, Gomez GA, Jacobson LE, Pless JE, Broadie TA. Fatal blunt aortic injuries: a review of 242 autopsy cases. J Trauma. 2001;50(1):113–5.

    Article  CAS  PubMed  Google Scholar 

  22. Roth SM, Wheeler JR, Gregory RT, Gayle RG, Parent III FN, Demasi R, et al. Blunt injury of the abdominal aorta: a review. J Trauma. 1997;42(4):748–55.

    Article  CAS  PubMed  Google Scholar 

  23. Karmy-Jones R, Jurkovich GJ. Blunt chest trauma. Curr Probl Surg. 2004;41(3):211–380.

    Article  PubMed  Google Scholar 

  24. Jurkovich GJ, Esposito TJ, Maier RV. Resuscitative thoracotomy performed in the operating room. Am J Surg. 1992;163(5):463–8.

    Article  CAS  PubMed  Google Scholar 

  25. Hughes CW. Use of an intra-aortic balloon catheter tamponade for controlling intraabdominal hemorrhage in man. Surgery. 1954;36:65–8.

    CAS  PubMed  Google Scholar 

  26. Yang L, Chong-Qi T, Hai-Bo S, et al. Applying the abdominal aortic balloon occluding combined with blood pressure sensor of dorsal artery of foot to control bleeding during the pelvic and sacrum tumors surgery. J Surg Oncol. 2008;97:626–8.

    Article  PubMed  Google Scholar 

  27. Veith FJ, Gupta S, Daly V. Technique for occluding the supraceliac aorta through the abdomen. Surg Gynecol Obstet. 1980;51:426–8.

    Google Scholar 

  28. Miura F, Takada T, Ochiai T, et al. Aortic occlusion balloon catheter technique is useful for uncontrollable massive intraabdominal bleeding after hepato-pancreato-biliary surgery. J Gastrointest Surg. 2006;10(4):519–22.

    Article  PubMed  Google Scholar 

  29. Seibler J, DiPascuale T, Sagi HC. Use of temporary partial intra-iliac balloon occlusion for decreasing blood loss during open reduction and internal fixation of acetabular and pelvis fractures. J Orthop Trauma. 2012;26:e54–7.

    Article  Google Scholar 

  30. Harma M, Kunt AS, Andac MH, et al. Balloon occlusion of the descending aorta in the treatment of severe post-partum hemorrhage. Aust N Z J Obstet Gynaecol. 2004;44:170–1.

    Article  PubMed  Google Scholar 

  31. Matsuda M, Tanaka Y, Hino Y, et al. Transbrachial arterial insertion of aortic occlusion balloon catheter in patients with shock from ruptured abdominal aortic aneurysm. J Vasc Surg. 2003;38:1293–6.

    Article  PubMed  Google Scholar 

  32. Malina M, Veith F, Ayyash K, et al. Balloon occlusion of the aorta during endovascular repair of ruptured abdominal aortic aneurysm. J Endovasc Ther. 2005;12:556–9.

    Article  PubMed  Google Scholar 

  33. Spence PA, Lust RM, Chitwood Jr WR, et al. Transfemoral balloon aortic occlusion during open CPR improves myocardial and cerebral blood flow. J Surg Res. 1990;49:217–21.

    Article  CAS  PubMed  Google Scholar 

  34. Sesma J, Labandeira J, Sara MJ, et al. Effect of intra-aortic occlusion balloon in external thoracic compressions during CPR in pigs. Am J Emerg Med. 2002;20:453–62.

    Article  CAS  PubMed  Google Scholar 

  35. White JM, Cannon JW, Stannard A, et al. Endovascular balloon occlusion of the aorta is superior to resuscitative thoracotomy with aortic cross-clamping in a porcine model of hemorrhagic shock. Surgery. 2011;150:400–9.

    Article  PubMed  Google Scholar 

  36. Avaro JP, Mardelle V, Roch A, et al. Forty minute endovascular balloon occlusion increases survival in an experimental model of uncontrolled hemorrhagic shock caused by abdominal trauma. J Trauma. 2011;71:720–5.

    Article  CAS  PubMed  Google Scholar 

  37. Gupta BK, Khaneja SC, Flores L, et al. The role of intra-aortic balloon occlusion in penetrating trauma. J Trauma. 1989;29:861–5.

    Article  CAS  PubMed  Google Scholar 

  38. Martinelli T, Thony F, Declety P, et al. Intra-aortic balloon occlusion to salvage patients with life-threatening hemorrhagic shock from pelvic fractures. J Trauma. 2010;68:942–8.

    PubMed  Google Scholar 

  39. Brenner ML, Moore LJ, DuBose JJ, Tyson GH, McNutt MK, Albarado RP, Holcomb JB, Scalea TM, Rasmussen TE. A clinical series of resuscitative endovascular balloon occlusion of the aorta for hemorrhage control and resuscitation. J Trauma Acute Care Surg. 2013;75(3):506–11.

    Article  PubMed  Google Scholar 

  40. Starnes BW, Quiroga E, Hutter C, Tran NT, Hatsukami T, Meissner M, et al. Management of ruptured abdominal aortic aneurysm in the endovascular era. J Vasc Surg. 2010;51(1):9–17.

    Article  PubMed  Google Scholar 

  41. Azizzadeh A, Valdes J, Miller CC, et al. The utility of intravascular ultrasound compared to angiography in the diagnosis of blunt traumatic aortic injury. J Vasc Surg. 2011;53(3):608–14.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Vascular Trauma, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, USA

    Megan L. Brenner M.D., M.S., R.P.V.I., F.A.C.S.

  2. University of Maryland Medical Center, Baltimore, MD, USA

    Melanie Hoehn M.D.

Authors
  1. Megan L. Brenner M.D., M.S., R.P.V.I., F.A.C.S.
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  2. Melanie Hoehn M.D.
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Editor information

Editors and Affiliations

  1. Department of Trauma, R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA

    Thomas M. Scalea

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Brenner, M.L., Hoehn, M. (2015). Endovascular Therapy in Trauma. In: Scalea, T. (eds) The Shock Trauma Manual of Operative Techniques. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2371-7_19

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  • DOI: https://doi.org/10.1007/978-1-4939-2371-7_19

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-2370-0

  • Online ISBN: 978-1-4939-2371-7

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