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

Adil Aijaz Shah, Abdul Rehman, Adil Hussain Haider, Raza Sayani, Raza Hasnain Sayyed, Kamran Ali, Syed Nabeel Zafar, Zia ur Rehman, Hasnain Zafar

Research output: Contribution to journalArticle

Abstract

Introduction: Interventional 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. Methods: Adult 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. Results: Thirty 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. Conclusion: With 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.

Original languageEnglish (US)
Pages (from-to)34-40
Number of pages7
JournalInternational Journal of Surgery
Volume18
DOIs
StatePublished - Jun 1 2015
Externally publishedYes

Fingerprint

Delivery of Health Care
Wounds and Injuries
Interventional Radiology
Injury Severity Score
Length of Stay
Hemorrhage
Trauma Centers
Liver
Hospital Mortality
Resuscitation
Patient Care
Emergencies
Arteries
Tomography
Demography

Keywords

  • Angiography
  • Embolization
  • Hemorrhage
  • Interventional radiology
  • Low-middle income country
  • Pakistan
  • Trauma

ASJC Scopus subject areas

  • Surgery

Cite this

Angiographic embolization for major trauma in a low-middle income healthcare setting - A retrospective review. / Shah, Adil Aijaz; Rehman, Abdul; Haider, Adil Hussain; Sayani, Raza; Sayyed, Raza Hasnain; Ali, Kamran; Zafar, Syed Nabeel; Rehman, Zia ur; Zafar, Hasnain.

In: International Journal of Surgery, Vol. 18, 01.06.2015, p. 34-40.

Research output: Contribution to journalArticle

Shah, AA, Rehman, A, Haider, AH, Sayani, R, Sayyed, RH, Ali, K, Zafar, SN, Rehman, ZU & Zafar, H 2015, 'Angiographic embolization for major trauma in a low-middle income healthcare setting - A retrospective review', International Journal of Surgery, vol. 18, pp. 34-40. https://doi.org/10.1016/j.ijsu.2015.03.023
Shah, Adil Aijaz ; Rehman, Abdul ; Haider, Adil Hussain ; Sayani, Raza ; Sayyed, Raza Hasnain ; Ali, Kamran ; Zafar, Syed Nabeel ; Rehman, Zia ur ; Zafar, Hasnain. / Angiographic embolization for major trauma in a low-middle income healthcare setting - A retrospective review. In: International Journal of Surgery. 2015 ; Vol. 18. pp. 34-40.
@article{ee4c0763315b47dfa6a8339ad3181520,
title = "Angiographic embolization for major trauma in a low-middle income healthcare setting - A retrospective review",
abstract = "Introduction: Interventional 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. Methods: Adult 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. Results: Thirty 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. Conclusion: With 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.",
keywords = "Angiography, Embolization, Hemorrhage, Interventional radiology, Low-middle income country, Pakistan, Trauma",
author = "Shah, {Adil Aijaz} and Abdul Rehman and Haider, {Adil Hussain} and Raza Sayani and Sayyed, {Raza Hasnain} and Kamran Ali and Zafar, {Syed Nabeel} and Rehman, {Zia ur} and Hasnain Zafar",
year = "2015",
month = "6",
day = "1",
doi = "10.1016/j.ijsu.2015.03.023",
language = "English (US)",
volume = "18",
pages = "34--40",
journal = "International Journal of Surgery",
issn = "1743-9191",
publisher = "Elsevier BV",

}

TY - JOUR

T1 - Angiographic embolization for major trauma in a low-middle income healthcare setting - A retrospective review

AU - Shah, Adil Aijaz

AU - Rehman, Abdul

AU - Haider, Adil Hussain

AU - Sayani, Raza

AU - Sayyed, Raza Hasnain

AU - Ali, Kamran

AU - Zafar, Syed Nabeel

AU - Rehman, Zia ur

AU - Zafar, Hasnain

PY - 2015/6/1

Y1 - 2015/6/1

N2 - Introduction: Interventional 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. Methods: Adult 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. Results: Thirty 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. Conclusion: With 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.

AB - Introduction: Interventional 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. Methods: Adult 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. Results: Thirty 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. Conclusion: With 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.

KW - Angiography

KW - Embolization

KW - Hemorrhage

KW - Interventional radiology

KW - Low-middle income country

KW - Pakistan

KW - Trauma

UR - http://www.scopus.com/inward/record.url?scp=84930456135&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84930456135&partnerID=8YFLogxK

U2 - 10.1016/j.ijsu.2015.03.023

DO - 10.1016/j.ijsu.2015.03.023

M3 - Article

C2 - 25865084

AN - SCOPUS:84930456135

VL - 18

SP - 34

EP - 40

JO - International Journal of Surgery

JF - International Journal of Surgery

SN - 1743-9191

ER -