• IR
• emergency IR
• health human resources
• interventional radiology

• Endovascular treatment
• Stroke
• Traumatic cerebrovascular injury
• Vascular lesions

• Humans
• Endovascular Procedures/methods
• Brain Injuries, Traumatic/complications
• Cerebrovascular Trauma/surgery
• Cerebrovascular Trauma/therapy

• Mortality
• Reverse shock index multiplied by the Glasgow coma scale
• Trauma
• Triage

• Adult
• Humans
• Glasgow Coma Scale
• Retrospective Studies
• Hospital Mortality
• Brain Injuries, Traumatic
• Emergency Service, Hospital
• Wounds and Injuries

• Korean Disease Control and Prevention Agency (KDCA)

• Angiography
• Embolization
• NTDB
• Pelvis
• Trauma

• Adult
• Humans
• Male
• United States/epidemiology
• Middle Aged
• Retrospective Studies
• Trauma Centers
• Pelvis/diagnostic imaging
• Pelvis/injuries
• Embolization, Therapeutic/methods
• Angiography
• Fractures, Bone/therapy
• Pelvic Bones/diagnostic imaging
• Pelvic Bones/injuries

• Computed tomography
• Embolization
• Fracture
• Hematoma
• Pelvic ring
• Trauma

• Humans
• Middle Aged
• Retrospective Studies
• Tomography, X-Ray Computed
• Angiography
• Hematoma/diagnostic imaging
• Hematoma/etiology
• Hematoma/therapy
• Hemorrhage/diagnostic imaging
• Hemorrhage/etiology
• Hemorrhage/therapy
• Extravasation of Diagnostic and Therapeutic Materials/diagnostic imaging
• Extravasation of Diagnostic and Therapeutic Materials/therapy
• Fractures, Bone/complications
• Fractures, Bone/diagnostic imaging
• Fractures, Bone/therapy
• Embolization, Therapeutic
• Wounds, Nonpenetrating/complications
• Wounds, Nonpenetrating/diagnostic imaging
• Wounds, Nonpenetrating/therapy
• Multiple Trauma

• abdominal injuries
• angiography
• contrast media
• multidetector computed tomography
• trauma
• ultrasonography
• vascular injuries

• Humans
• Multidetector Computed Tomography
• Vascular System Injuries/diagnostic imaging
• Aneurysm, False/diagnostic imaging
• Aneurysm, False/etiology
• Contrast Media
• Retrospective Studies
• Angiography
• Abdominal Injuries/diagnostic imaging
• Wounds, Nonpenetrating/diagnostic imaging
• Wounds, Nonpenetrating/pathology
• Hemorrhage
• Sensitivity and Specificity

• radiologists
• trauma centers
• embolization, therapeutic

• Bleeding
• Embolization
• Endovascular
• Trauma

• Embolization
• Emergency department
• Interventional angiography
• Survival
• Trauma

• Humans
• Adult
• Male
• United States
• Trauma Centers
• Retrospective Studies
• Angiography
• Embolization, Therapeutic/methods
• Databases, Factual
• Injury Severity Score

• Angioembolization
• COVID-19
• Hemodynamics
• Hepatectomy
• Liver Injuries

• embolization
• emergency department
• interventional angiography
• outcome
• trauma

• Abdominal Injuries/therapy
• Adult
• Angiography
• Embolization, Therapeutic/methods
• Humans
• Male
• Retrospective Studies
• Spleen/injuries
• Trauma Centers
• United States
• Wounds, Nonpenetrating/therapy

• Blunt injury
• Clinical decision rule
• Embolization
• Hemostasis
• Interventional radiology

Endovascular embolization techniques are nowadays well established in the management of acute arterial bleedings. However, the education and training of the next generation of interventionalists are still based on the traditional apprenticeship model, where the trainee learns and practices directly at the patient, which potentially affects the patient’s safety. The objective of this study was to design and develop a standardized endovascular simulation concept for the training of acute bleeding embolizations, based on real-life cases.

An adaptable and cost-effective endovascular simulator was developed using an in-house 3D print laboratory. All thoracic and abdominal acute bleeding embolizations over more than a year with appropriate pre-interventional computed tomography scans were included to manufacture 3D printed vascular models. A peristaltic pump was used to generate pulsatile flow curves. Forty embolization cases were engaged in this study, and 27 cases were fully reproduced in the simulation setting (69.23%). The simulation success was significantly lower in pulmonary embolizations (p = 0.031) and significantly higher in soft tissue (p = 0.032) and coil embolizations (p = 0.045). The overall simulation success was 7.8 out of 10 available points.

Using stereolithography 3D printing in a standardized simulation concept, endovascular embolization techniques for treating acute internal hemorrhages in the chest and abdomen can be simulated and trained based on the patient-specific anatomy in a majority of the cases and at a broad spectrum of different causes.

The online version contains supplementary material available at 10.1186/s13244-022-01206-7.

• 3D Printing
• Arterial bleedings
• Coiling
• Embolization
• Simulation

To provide data on the safety and efficacy of renal arterial embolization (RAE) in patients with high-grade blunt renal injury.

Fifteen patients with high-grade blunt renal injury (AAST grades IV-V) admitted to our hospital from July 2014 to December 2019 were retrospectively reviewed in this study. Their clinical success rate and complications were investigated accordingly.

Fifteen patients with high-grade blunt renal injury, 13 men and 2 women with an average age of 41.6 years, including 11 hemodynamically unstable patients and 4 stable patients, were treated with RAE. Among these patients, 73.3% (11 of 15) had grade IV, and 26.7% (4 of 15) had grade V injuries, while 53.3% (8 of 15) patients had concomitant injuries. One patient received main RAE and 14 patients received selective RAE. The clinical success rate after the first embolization was 93.3% (14 of 15). RAE was repeated and was successfully performed in one patient with sustained hematuria. No significant difference in creatinine levels was found before and after embolization. During the follow-up period of 2–82 months, two patients required tube drainage due to urine leaks, one patient developed renal failure requiring renal replacement therapy, and one patient developed secondary hypertension.

RAE can provide a high success rate of hemostasis for both hemodynamically stable and unstable patients with high-grade blunt renal injury, and only minor complications are observed with this procedure.

• Decision‐making
• LASSO regression
• interventional radiology
• nonoperative management
• trauma

Approximately 1–3% of all trauma patients have a renal injury. Eighty percent of renal trauma is due to blunt injury, with the remainder due to penetrating trauma which is most often iatrogenic. Contrast enhanced computed tomography is used to triage patients and offers a quick and accurate assessment of any potential organ injury. If injury is present, The American Association for the Surgery of Trauma grading system can both grade renal injuries and be used to help guide management and intervention. Grades are assigned based on imaging and clinical features of renal trauma, and have prognostic and treatment implications for patients. The objective of this narrative review is to identify optimal management of patients with renal trauma, specifically which patients can be treated with endovascular interventions following renal trauma, which can be observed, and which would be best managed surgically. For hemodynamically stable patients with renal trauma, endovascular angiography and embolization is a non-invasive approach that can be used to control bleeding and potentially avoid surgery or nephrectomy in select cases. Future research is needed to determine if a specific antibiotic regimen is needed prior to or following embolization. Further research is needed to evaluate the effectiveness of endovascular management of high-grade renal trauma (grade V). Complications of renal embolization include short-term hypertension, long term hypertension in cases of significant ischemia, acute kidney injury, and infection.

• Renal trauma
• renal angiography
• renal artery embolization
• shattered kidney

• Hemorrhage
• Interventional radiology
• Trans-arterial embolization
• Wounds and injuries

Massive bleeding is a major preventable cause of early death in trauma. It often requires surgical and/or endovascular intervention. We aimed to describe the utilization of angioembolization in patients with abdominal and pelvic traumatic bleeding at a level 1 trauma center.

We conducted a retrospective analysis for all trauma patients who underwent angioembolization post-traumatic bleeding between January 2012 and April 2018. Patients’ data and details of injuries, angiography procedures and outcomes were extracted from the Qatar national trauma registry.

A total of 175 trauma patients underwent angioembolization during the study period (103 for solid organ injury, 51 for pelvic injury and 21 for other injuries). The majority were young males. The main cause of injury was blunt trauma in 95.4% of the patients. The most common indication of angioembolization was evident active bleeding on the initial CT scan (contrast pool or blushes). Blood transfusion was needed in two-third of patients. The hepatic injury cases had higher ISS, higher shock index and more blood transfusion. Absorbable particles (Gelfoam) were the most commonly used embolic material. The overall technical and clinical success rate was 93.7% and 95%, respectively, with low rebleeding and complication rates. The hospital and ICU length of stay were 13 and 6 days, respectively. The median injury to intervention time was 320 min while hospital arrival to intervention time was 274 min. The median follow-up time was 215 days. The overall cohort mortality was 15%.

Angioembolization is an effective intervention to stop bleeding and support nonoperative management for both solid organ injuries and pelvic trauma. It has a high success rate with a careful selection and proper implementation.

• angioembolization
• bleeding
• injury
• pelvic
• solid organ
• trauma

High-flow priapism is a persistent partial penile tumescence, related to high flow arterial blood into the corpora. It is much less common than the low-flow priapism, and history of trauma is the more common aetiology. In the treatment of high flow priapism, super-selective embolization is considered treatment of choice when conservative treatment fails as reported in the “European Association of Urology Guidelines on Priapism”, but there are only few series reporting the outcome, the efficacy of different embolic materials and these studies are uncontrolled and relatively small.

The aim of this study is to review the literature to outline the state of the art of this interventional treatment and to analyse the outcome of the different embolic agents.

Through Medline database (via PubMed) we searched all the English-language published articles related to priapism. Keywords were chosen according to MeSH terms. We selected case-series from 1990 to 2020 including at least five cases of high-flow priapism. The variables extracted from the selected articles were: number of patients, mean age, diagnostic imaging modality, mono or bilateral involvement of the arteries, embolization material, technical success, clinical success, complications, recurrence rate and type of reintervention, mean follow up, onset of erectile dysfunction.

We analyzed 11 papers. A total of 117 patients, mean age of 30 years, were studied during a period of 8 to 72 months. Technical success average was 99%, varying from 93 to 100%. Clinical success average was 88%, varying from 56 to 100%. After two or more treatments, resolution of priapism was obtained in all patients. No major adverse events registered. Recurrence rate of 21% (25/117) was observed, and only 4 patients underwent surgery. A total of 17 patients (15%) developed erectile dysfunction (ED). We also created a subgroup analysis focusing on specific outcome with different types of materials. Technical success was very high, 100% for all materials except for PVA particles Clinical Success was at least 70% with all kind of material. Best result was obtained with gel-foam (89%) and the worse with PVA (70%).

Our data suggested comparable outcomes using different types of materials. In line with the last evidences we suggest that the choice of the embolic material should be selected basing on the expertise of the operator, the characteristic of the fistula and characteristic of the patients. (www.actabiomedica.it)

• bariatric surgery
• bleeding
• complications
• image-guided surgery
• interventional radiology
• minimally invasive surgery

• Abdominopelvic trauma
• Hypovolemic shock
• Transcatheter arterial embolization

Objective

The aim of this study was to describe the outcome of the use of interventional radiological procedures (IRP) (angioembolization) in critically injured children.

Methods

A retrospective review of medical records of all children who underwent an IRP from January 2010 to December 2015 was done. Data were collected on a structured proforma and results are presented as mean with standard deviation and frequency with percentages.

Result

Eighteen patients were identified who underwent IRP during the study period. The mean age was 10.4 ± 4.3 years and 10 (55%) were males. Ten patients had a road traffic accident, four had a history of fall, one patient had glass cut pelvic injury, and two patients had blunt abdominal trauma, while one patient had bleeding secondary to hemipelvectomy. The genitourinary system was involved in five patients, liver in four, and spleen in two and pancreas in one patient. Bleeding was from branches of internal iliac artery in seven patients, hepatic artery in three patients, splenic artery in two patients, and middle colic artery in one patient, while one patient had blood oozing from the bone after hemi-pelvictomy. Four French vascular access sheath was placed under ultrasound guidance; this was followed by the placement of C1 catheter (Cordis, Miami, FL). After vessel identification, a 2.7F Progreat microcatheter (Terumo, Tokyo) was used for super-selective cannulation of the bleeding vessel. Intravascular coil, polyvinyl alcohol (PVA) particles, or gel foam was used for the embolization of bleeding vessels. No procedural complications were observed except minor oozing in one patient. One patient expired due to multiorgan dysfunction.

Conclusion

Angioembolization is a useful and relatively safe procedure in the management of vitally stable children with hemorrhagic abdominopelvic injuries. However, further studies may be needed to evaluate the efficacy and cost-effectiveness of this practice, especially in resource-constrained settings.

• interventional radiology
• pediatric
• trauma

• Coils
• Gelfoam
• Haemorrhage
• Intervention
• Pelvic trauma
• Trans-arterial embolisation

• Pelvic trauma
• embolization
• imaging

• Liver trauma
• Non-operative management
• Surgical treatment

Abdominopelvic trauma (APT) remains a leading cause of morbidity and mortality in the 15- to 44-year-old age group in the Western World. It can be life-threatening as abdominopelvic organs, specifically those in the retroperitoneal space, can bleed profusely. APT is divided into blunt and penetrating types. While surgery is notably considered as a definitive solution for bleeding control, it is not always the optimum treatment for the stabilization of a polytrauma patient. Over the past decades, there has been a shift toward more sophisticated strategies, such as non-operative management of abdominopelvic vascular trauma for haemodynamically stable patients. Angiographic embolization for bleeding control following blunt and/or penetrating intra- and retroperitoneal injuries has proven to be safe and effective. Embolization can achieve hemostasis and salvage organs without the morbidity of surgery, and the development and refinement of embolization techniques has widened the indications for non-operative treatment in solid organ injury. Moreover, advances in computed tomography provided more efficient scanning times with improved image quality. While surgery is still usually recommended for patients with penetrating injuries, non-operative management can be effectively used as well as an alternative treatment. We review indications, technical considerations, efficacy, and complication rates of angiographic embolization in APT.

• abdominopelvic
• angiography
• embolization
• emergency
• trauma

• Kidney
• arterial embolization
• blunt trauma
• iatrogenic lesion
• interventional radiology