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Pediatric abdominal and pelvic trauma: safety and efficacy of arterial embolization
Nghia-Jack Vo1, Morgan Althoen2, Daniel S Hippe3
1Department of Radiology and Section of Pediatric Interventional Radiology and Vascular and Interventional Radiology, Seattle Children's Hospital and the University of Washington, Seattle, Washington.
Insights
Arterial embolization is a safe and effective treatment for pediatric blunt abdominal and pelvic trauma, achieving 87% hemorrhage control with a low complication rate. This interventional radiology technique should be considered for pediatric trauma management.
Area of Science:
- Interventional Radiology
- Pediatric Trauma Surgery
- Vascular Embolization
Background:
- Transcatheter embolization is established for adult trauma but lacks pediatric evidence.
- Pediatric blunt abdominal and pelvic trauma requires effective hemorrhage control strategies.
Purpose of the Study:
- To assess the safety and efficacy of arterial embolization for pediatric blunt abdominal and pelvic trauma.
- To evaluate hemorrhage control rates and complications associated with the procedure in children.
Main Methods:
- Retrospective review of 97 pediatric patients undergoing angiography for blunt trauma over 11 years.
- Angiography and embolization performed for hepatic, renal, splenic, retroperitoneal, or pelvic injuries with hemorrhage.
- Assessment of clinical success, complications, and mortality rates.
Main Results:
- 54 of 97 patients (56%) underwent embolization at 62 sites, primarily targeting the pelvis (39), liver (8), kidney (7), and spleen (6).
- Effective hemorrhage control was achieved in 47 patients (87%).
- Complications occurred in 7% (4 of 54 patients), including hepatic abscess, bile leak, and urinary incontinence. Overall mortality was 22%, largely due to traumatic brain injury.
Conclusions:
- Arterial embolization is relatively safe and effective for pediatric blunt abdominal and pelvic trauma.
- Angiography with embolization should be integrated into treatment algorithms for pediatric trauma patients.
Purpose:
Although transcatheter embolization is a well established technique to treat adults in the trauma setting, evidence is lacking in the pediatric population. This study assesses the safety and efficacy of arterial embolization for blunt abdominal and pelvic trauma in the pediatric population.
Materials And Methods:
A retrospective review of abdominal and pelvic angiograms in 97 pediatric patients with blunt trauma was conducted over an 11-year period. Abdominal angiography and embolization was performed for ongoing hepatic, renal, splenic, or nonvisceral retroperitoneal injury. Pelvic angiography was performed in the setting of pelvic fracture with ongoing pelvic hemorrhage. Complications and clinical success rates of these procedures were assessed.
Results:
Of the 97 pediatric patients who underwent angiography for acute abdominal or pelvic trauma, 54 (56%) required embolization involving 62 separate sites. Injury severity score greater than 15 was present in 94% of patients. Targets of embolization included the pelvis (n = 39), liver (n = 8), kidney (n = 7), spleen (n = 6), and retroperitoneum (n = 2). Effective hemorrhage control was achieved in 47 patients (87%). Overall mortality rate was 22% (12 of 54), with most deaths related to traumatic brain injury. Five complications occurred in four patients (7%), including three major complications (hepatic abscess, bile leak, and urinary incontinence).
Conclusions:
Angiography and embolization is relatively safe and potentially effective in the setting of abdominal and pelvic trauma in the pediatric population. Angiography with embolization should be considered in the treatment algorithm for this patient population.
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Assessment:
1. Clinical Evaluation:
History: