Angiographic embolization for major trauma in a low-middle income healthcare setting – A retrospective review

• Advances in trauma care have made non-operative management of trauma possible and preferable over surgical interventions.
• Angioembolization (AE) is a safe adjunct to surgical intervention in the management of hemodynamically stable trauma patients.
• AE is resource intensive and is largely lacking in developing healthcare systems.
• Success of AE in trauma management in low-middle income settings can parallel models in Western healthcare systems.
• AE for major trauma can be complication free when adequate interventional radiological facilities and expertise are present.
• The availability of equipment and expertise makes the usage of AE for the care of trauma patients in LMIC settings is possible.

IntroductionInterventional radiology (IR) provides a range of adjunctive techniques to assist with hemorrhage control after trauma that can be employed pre- or post-operatively. The role of IR in lower-middle income countries (LMICs) remains unexplored. This study describes the use of adjunctive angioembolization (AE) in severely injured patients following its recent implementation at an urban trauma center in a LMIC.MethodsAdult patients (≥16 years) requiring AE from 2011 to 2013 at a single trauma-care facility were included. Data was collected on demographic parameters, transfer status, injury severity score (ISS), emergency resuscitation characteristics, AE and operative characteristics, complications, and in-hospital mortality. Descriptive analyses were performed.ResultsThirty six patients underwent AE for trauma-related hemorrhagic complications and were included in the study. Average age was 31.5 (±11.3) years with a male preponderance (91.7%). Penetrating trauma (61.1%) was the most common type of injury. The primary mechanism of injury was gunshot (58.3%). The median ISS was 24 (IQR: 20–29). Pre-operative AE was performed in 23 (63.9%) patients and these patients had a lower median ISS (22) than those who underwent post-operative AE (p = 0.015). Hepatic (55.6%) and pelvic (33.3%) trauma more commonly required radiological intervention. Bleeding from the right hepatic (n = 14), and the right internal iliac (n = 6) arteries and/or their branches, were more often embolized. Microcoils were the preferred AE agents (61.1%). Median length of hospital stay was 7.5 (IQR: 3–14) days. Eight (22.2%) patients did not survive.ConclusionWith the availability of multi-detector computed tomography and a dedicated interventional radiology suite, implementation of AE for the care of trauma patients in LMIC settings is possible.