[Vascular interventional radiology: a fundamental procedure for the management of paediatric trauma]

The management of active bleeding with haemodinamic lability in the paediatric trauma patient is difficult and generally leads to damage control surgery. Vascular Interventional Radiology (VIR) techniques are useful for the diagnosis as for the definitive treatment.

The aim of our study was to describe our experience and evaluate effectiveness of VIR in the management of the paediatric trauma patient with active bleeding signs.

Retrospective analysis (2003-2014) of politraumatic patients who showed contrast blush on computed tomography and then treated by VIR techniques.

In the reported study period 16 patients underwent VIR procedures. Medium age was 13 years (5-17). The most frequent lesion mechanism was traffic accident (8 out of 17) and 93,75% were blunt traumas. Findings on initial Computed Tomography were 12 contrast blushes and 2 absences of arterial flow. In 2 cases the contrast blush appeared 48 hours after the accident. Arteriography allowed us to localize the bleeding vessels in all the cases, performing selective or supraselective renal (7), pelvic (5), hepatic (3), splenic (1) and intercostal (1) embolization. One patient required an endoprothesis for renal revascularization. Two cases needed additional surgical procedures (2 nephrectomies) because of complete section of the renal artery (1) and disruption of the ureteropelvic junction (1). One case required hemofiltration in relation to rhabdomyolysis.

In our experience VIR is a valuable diagnostic and therapeutic procedure for the management of paediatric trauma patients, with high effectiveness and a low complication rate.