“Beyond saving lives”: Current perspectives of interventional radiology in trauma

Table 1 Embolizing agents used in traumatic injuries

Embolizing agent	Indications	Advantages	Demerits
Permanent
Coil (covered with thrombogenic fibers) (Size of coil should be 20%-30% more than the target vessel size)	Active contrast extravasation Pseudoaneurysm	Rapid and effective control of bleeding Agent of choice when site of bleeding can be approached superselectively Relatively cheap (standard coils)	Reduced effectiveness in coagulopathy which hampers effective thrombosis Limited utility when target site can not be selectively approached
Non-absorbable particles (e.g., Polyvinyl alcohol)	Injury to terminal vessels	Permanent control of bleeding Adjunct to gelfoam	Tendency to clump and aggregate at the catheter site leading to proximal embolization, catheter block Non targeted embolization due to small size Tissue necrosis No added benefit over gelfoam, incurs additional cost
Liquid embolic agent [e.g., glue(N-butyl cyanoacrylate)]	As an alternative to coil especially in rebleeding	Rapid control of bleeding in hemodynamically unstable patients	Expertise for controlled delivery at target site Propensity for non targeted distal embolization leading to infarct or necrosis Rarely glue embolization of pulmonary circulation
Amplatzer vascular plug (AGA Medical Corporation, Plymouth, MN, United States) Available in various sizes	Large caliber vessel or large AVF (large size plug)	Single device (mesh shaped metal coil): Deployed with much greater accuracy and replaces the need of multiple coils	Costly Less beneficial in cases of distal vascular injury with good collateralization as it is deployed in proximal larger branch
Temporary
Gelatin sponge (CuraMedical, Assendelft, the Netherlands) Either in the form of pledgets (cut from gelfoam sheet) or slurry (non- ionic iodinated contrast mixed with gelfoam)	Cornerstone of IR in trauma: Controls majority of haemorrhage	Rapid, effective temporary occlusion of bleeding site Easily available and cheap Can be easily refashioned to the size of target artery	Non-targeted embolization to proximal branches can occur in case of rapid injection Resorbed after 3 wk: Potential risk of delayed haemorrhage Reduced effectiveness in impaired hemostasis Small risk of infection due to entrapped air during preparation
Autologous clot	Nonselective and rapid control of haemorrhage	Easy availability No cost	Clot dissolution in cases of coagulopathy and hemodilution
Starch microparticles	Usually complete reperfusion after 60 min, less tissue damage	Temporary occlusion is usually complete Uniform distribution	Allergic, non-target embolization