Interventional Radiology: Interventions and Techniques in Trauma

Purpose of Review: The purpose of the review was to describe how interventional radiology procedure contribute in the management of the trauma patient, distinguish the situations where evidence has demonstrated improved outcomes with its use, acknowledge the limitations and controversies of the techniques and their place on management algorithms, and mention some particular situations where, despite lack of evidence, the procedures are commonly employed. Recent Findings: CT seems to be a better indicator of significant vascular injury with the associated high risks when compared to a discordant negative conventional angiogram. Empiric embolization of the injured segments might improve outcomes in these settings. Finding a subcapsular splenic hematoma in CT is an independent risk factor associated with high rates of NOM failure. Prophylactic interventions are recommended, even in low grade splenic injuries, when a subcapsular splenic hematoma is present. In liver trauma, the injured liver is more susceptible to ischemic injury from arterial embolization with subsequent infarct, biloma, and abscess formation. When needed, angio-embolization should be performed as selective as possible. Subsequent surveillance for ischemic liver injury complications should be instated and, if required, timely therapeutic interventions considered. Summary: The initial CT scan findings of “contrast blush” and high-grade solid organ injury are some of the best early predictors for failure of the non-operative management (NOM) in the trauma patient. Endovascular interventions improve the outcomes of NOM when clinical or imaging findings indicate a high risk for continued or delayed hemorrhage. Angio-embolization improves the outcomes of unstable hemorrhagic pelvic fractures and is useful as complement of damage control surgeries or when the surgical interventions fail to control vascular injuries.