Angiographic embolization for arrest of bleeding after penetrating trauma to the abdomen

George C. Velmahos, Demetrios Demetriades, Santiago Chahwan, Hugo Gomez, Sue Ellen Hanks, James A. Murray, Juan A. Asensio, Thomas V. Berne

Research output: Contribution to journalArticle

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Abstract

Background: Angiographic embolization is an effective technique to control bleeding after blunt trauma to the liver or pelvis. Its role in penetrating trauma to the abdomen has not been studied. Methods: From January 1992 to May 1998, 40 patients underwent angiography for bleeding resulting from intra-abdominal penetrating injuries (33 gunshot wounds, 7 stab wounds). Angiographic embolization of intraperitoneal or retroperitoneal vessels was performed by standard angiographic techniques with gelatin sponge and/or coils. Data were extracted from medical records, radiology data bank, trauma registry, and morbidity/mortality records, and compared by Student's t test and chi-square test. The main outcome measures were failure of angiographic embolization to control bleeding and complications of angiographic embolization. Results: Angiography was performed during a course of nonoperative management in 6 patients (group A), because of failure to control bleeding surgically in 23 (group B), and because of late vascular complications after an initially successful operation in 11 more (group C). In 32 patients, angiography revealed active bleeding; 29 (91%) underwent successful angiographic embolization. Of the remaining 3 patients, 2 were successfully managed surgically (1 each from groups A and B) and 1 died despite multiple surgical maneuvers (group B). One patient who developed postoperatively a large, bleeding superior mesenteric artery pseudoaneurysm, suffered extensive bowel necrosis after angiographic embolization. No other significant complication was related to angiographic embolization. Conclusions: Angiographic embolization after penetrating injuries to the abdomen is safe and effective for a small number of selected patients. It is a valuable tool for bleeding control when surgery has failed. It may be ideal for control of late vascular complications when reoperation is not desirable. It may prove to be a useful adjunct in the nonoperative treatment of selected injuries. Copyright (C) 1999 Excerpta Medica Inc.

Original languageEnglish
Pages (from-to)367-373
Number of pages7
JournalAmerican Journal of Surgery
Volume178
Issue number5
DOIs
StatePublished - Nov 1999
Externally publishedYes

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Abdomen
Hemorrhage
Wounds and Injuries
Angiography
Blood Vessels
Stab Wounds
Abdominal Injuries
Gunshot Wounds
Superior Mesenteric Artery
False Aneurysm
Porifera
Chi-Square Distribution
Gelatin
Pelvis
Reoperation
Radiology
Medical Records
Registries
Necrosis
Outcome Assessment (Health Care)

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Velmahos, G. C., Demetriades, D., Chahwan, S., Gomez, H., Hanks, S. E., Murray, J. A., ... Berne, T. V. (1999). Angiographic embolization for arrest of bleeding after penetrating trauma to the abdomen. American Journal of Surgery, 178(5), 367-373. https://doi.org/10.1016/S0002-9610(99)00212-3

Angiographic embolization for arrest of bleeding after penetrating trauma to the abdomen. / Velmahos, George C.; Demetriades, Demetrios; Chahwan, Santiago; Gomez, Hugo; Hanks, Sue Ellen; Murray, James A.; Asensio, Juan A.; Berne, Thomas V.

In: American Journal of Surgery, Vol. 178, No. 5, 11.1999, p. 367-373.

Research output: Contribution to journalArticle

Velmahos, GC, Demetriades, D, Chahwan, S, Gomez, H, Hanks, SE, Murray, JA, Asensio, JA & Berne, TV 1999, 'Angiographic embolization for arrest of bleeding after penetrating trauma to the abdomen', American Journal of Surgery, vol. 178, no. 5, pp. 367-373. https://doi.org/10.1016/S0002-9610(99)00212-3
Velmahos, George C. ; Demetriades, Demetrios ; Chahwan, Santiago ; Gomez, Hugo ; Hanks, Sue Ellen ; Murray, James A. ; Asensio, Juan A. ; Berne, Thomas V. / Angiographic embolization for arrest of bleeding after penetrating trauma to the abdomen. In: American Journal of Surgery. 1999 ; Vol. 178, No. 5. pp. 367-373.
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abstract = "Background: Angiographic embolization is an effective technique to control bleeding after blunt trauma to the liver or pelvis. Its role in penetrating trauma to the abdomen has not been studied. Methods: From January 1992 to May 1998, 40 patients underwent angiography for bleeding resulting from intra-abdominal penetrating injuries (33 gunshot wounds, 7 stab wounds). Angiographic embolization of intraperitoneal or retroperitoneal vessels was performed by standard angiographic techniques with gelatin sponge and/or coils. Data were extracted from medical records, radiology data bank, trauma registry, and morbidity/mortality records, and compared by Student's t test and chi-square test. The main outcome measures were failure of angiographic embolization to control bleeding and complications of angiographic embolization. Results: Angiography was performed during a course of nonoperative management in 6 patients (group A), because of failure to control bleeding surgically in 23 (group B), and because of late vascular complications after an initially successful operation in 11 more (group C). In 32 patients, angiography revealed active bleeding; 29 (91{\%}) underwent successful angiographic embolization. Of the remaining 3 patients, 2 were successfully managed surgically (1 each from groups A and B) and 1 died despite multiple surgical maneuvers (group B). One patient who developed postoperatively a large, bleeding superior mesenteric artery pseudoaneurysm, suffered extensive bowel necrosis after angiographic embolization. No other significant complication was related to angiographic embolization. Conclusions: Angiographic embolization after penetrating injuries to the abdomen is safe and effective for a small number of selected patients. It is a valuable tool for bleeding control when surgery has failed. It may be ideal for control of late vascular complications when reoperation is not desirable. It may prove to be a useful adjunct in the nonoperative treatment of selected injuries. Copyright (C) 1999 Excerpta Medica Inc.",
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AU - Chahwan, Santiago

AU - Gomez, Hugo

AU - Hanks, Sue Ellen

AU - Murray, James A.

AU - Asensio, Juan A.

AU - Berne, Thomas V.

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N2 - Background: Angiographic embolization is an effective technique to control bleeding after blunt trauma to the liver or pelvis. Its role in penetrating trauma to the abdomen has not been studied. Methods: From January 1992 to May 1998, 40 patients underwent angiography for bleeding resulting from intra-abdominal penetrating injuries (33 gunshot wounds, 7 stab wounds). Angiographic embolization of intraperitoneal or retroperitoneal vessels was performed by standard angiographic techniques with gelatin sponge and/or coils. Data were extracted from medical records, radiology data bank, trauma registry, and morbidity/mortality records, and compared by Student's t test and chi-square test. The main outcome measures were failure of angiographic embolization to control bleeding and complications of angiographic embolization. Results: Angiography was performed during a course of nonoperative management in 6 patients (group A), because of failure to control bleeding surgically in 23 (group B), and because of late vascular complications after an initially successful operation in 11 more (group C). In 32 patients, angiography revealed active bleeding; 29 (91%) underwent successful angiographic embolization. Of the remaining 3 patients, 2 were successfully managed surgically (1 each from groups A and B) and 1 died despite multiple surgical maneuvers (group B). One patient who developed postoperatively a large, bleeding superior mesenteric artery pseudoaneurysm, suffered extensive bowel necrosis after angiographic embolization. No other significant complication was related to angiographic embolization. Conclusions: Angiographic embolization after penetrating injuries to the abdomen is safe and effective for a small number of selected patients. It is a valuable tool for bleeding control when surgery has failed. It may be ideal for control of late vascular complications when reoperation is not desirable. It may prove to be a useful adjunct in the nonoperative treatment of selected injuries. Copyright (C) 1999 Excerpta Medica Inc.

AB - Background: Angiographic embolization is an effective technique to control bleeding after blunt trauma to the liver or pelvis. Its role in penetrating trauma to the abdomen has not been studied. Methods: From January 1992 to May 1998, 40 patients underwent angiography for bleeding resulting from intra-abdominal penetrating injuries (33 gunshot wounds, 7 stab wounds). Angiographic embolization of intraperitoneal or retroperitoneal vessels was performed by standard angiographic techniques with gelatin sponge and/or coils. Data were extracted from medical records, radiology data bank, trauma registry, and morbidity/mortality records, and compared by Student's t test and chi-square test. The main outcome measures were failure of angiographic embolization to control bleeding and complications of angiographic embolization. Results: Angiography was performed during a course of nonoperative management in 6 patients (group A), because of failure to control bleeding surgically in 23 (group B), and because of late vascular complications after an initially successful operation in 11 more (group C). In 32 patients, angiography revealed active bleeding; 29 (91%) underwent successful angiographic embolization. Of the remaining 3 patients, 2 were successfully managed surgically (1 each from groups A and B) and 1 died despite multiple surgical maneuvers (group B). One patient who developed postoperatively a large, bleeding superior mesenteric artery pseudoaneurysm, suffered extensive bowel necrosis after angiographic embolization. No other significant complication was related to angiographic embolization. Conclusions: Angiographic embolization after penetrating injuries to the abdomen is safe and effective for a small number of selected patients. It is a valuable tool for bleeding control when surgery has failed. It may be ideal for control of late vascular complications when reoperation is not desirable. It may prove to be a useful adjunct in the nonoperative treatment of selected injuries. Copyright (C) 1999 Excerpta Medica Inc.

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