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Trauma is still a challenge for many professional figures in the medical field. When the patient is bleeding a rapid and effective management is required to prevent cardiovascular shock and death.
Interventional radiology plays a key role in the stable patient, providing multiple treatment options .
DIAGNOSTIC WORKUP
Angiographic-CT is the imaging test of choice in patients with suspected bleeding. Basal acquisition is performed for the identification of the hematoma and bone fractures. Arterial, Portal and Venous phases are subsequently performed in order to identify the bleeding vessel.
PROCEDURAL STEPS AND TECHNIQUE
Vascular access is performed usually at the common femoral or radial artery site. Pain control is achieved with local anesthesia. Vessel puncture is performed at free-hand or under ultrasound/fluoroscopic guidance with a 18G cannula. Once the needle is in the vascular lumen a guidewire is passed through the needle and an arterial vascular sheath is finally placed in the artery. On the basis of the CT examination a diagnostic catheter is placed in large vessel as near as possible to the suspected bleeding vessels. A diagnostic angiography run is performed and bleeding site is usually identified. A microcatheter is moved to the site of bleeding and embolization is performed with the most appropriate embolic agent (Coils, Glue, PVA, Gelfoam, Plug, Stent, ecc…). A final diagnostic angiographic run confirms the bleeding cessation.
