Negative catheter angiography after vascular contrast extravasations on computed tomography in blunt torso trauma: an experience review of a clinical dilemma

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Yu-Pao Hsu¹  Erh-Hao Liu¹  Shih-Ching Kang¹  Being-Chung Lin¹  Yon-Cheong Wong²  Kuo-Ching Yuan¹ 

[1] Trauma and Critical Care Center, Division of General Surgery, Department of Surgery, Chang-Gung Memorial Hospital, Chang-Gung University, Linkou, Taiwan;Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang-Gung Memorial Hospital, Chang-Gung University, Linkou, Taiwan

关键词: Negative angiography;    Embolization;    Angiography;    Computed tomography;    Contrast extravasation;    Pelvic injury;    Blunt abdominal injury;    Trauma;   

Others  :  826483
DOI  :  10.1186/1757-7241-20-46

 received in 2012-02-21, accepted in 2012-06-15,  发布年份 2012

【 摘 要 】

Background

Catheter angiography is often arranged when vascular contrast extravasations on computed tomography (VCEC) presents after blunt torso trauma. However, catheter angiograph can be negative for bleeding and further management about this condition is not well discussed. The purpose of this study was a review of our experience of this discrepancy and to propose management principle.

Methods

We conducted a retrospective analysis of patients who received catheter angiography due to VCEC after blunt torso trauma at a level one trauma center in Taiwan from January 1, 2006 to December 31, 2009. Patient data abstracted included demographic data, injury mechanism, Injury Severity Score, vital signs and laboratory data obtained in the emergency department, CT and angiography results, embolization status, rebleeding and outcome. Analysis was performed according to angiographic results, VCEC sites, and embolization status.

Results

During the study period, 182 patients received catheter angiography due to VCEC, and 48 (26.4%) patients had negative angiography. The kidney had the highest incidence (31.7%) for a discrepant result. Non-selective proximal embolization under negative angiography was performed mostly in pelvic fracture and spleen injury. Successful treatment without embolization after negative angiography was seen in the liver, kidney and pelvic fractures. However, some rebleeding happened in pelvic fractures with VCEC even after embolization on negative angiography.

Conclusions

A negative catheter angiography after VCEC is possible in blunt torso trauma, and this occurs most in kidney. Embolization or not under this discrepancy requires an integrated consideration of injury site, clinical presentations, and the risk of rebleeding. Liver and kidney in blunt torso trauma can be managed successfully without embolization when catheter angiography is negative for bleeding after VCEC.

【 授权许可】

   
2012 Yuan et al.; licensee BioMed Central Ltd.

【 图 表 】

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