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

doi:10.1016/j.ijsu.2015.03.023

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

Int J Surg. 2015 Jun:18:34-40. doi: 10.1016/j.ijsu.2015.03.023. Epub 2015 Apr 10.

Authors

Adil Aijaz Shah¹, Abdul Rehman², Adil Hussain Haider¹, Raza Sayani³, Raza Hasnain Sayyed², Kamran Ali², Syed Nabeel Zafar⁴, Zia-ur Rehman², Hasnain Zafar⁵

Affiliations

¹ Center for Surgery and Public Health (CSPH), Brigham and Women's Hospital, Harvard School of Public Health and Harvard Medical School, Boston, MA, USA.
² Aga Khan University Hospital, Department of Surgery, Karachi, Pakistan.
³ Aga Khan University, Department of Radiology, Karachi, Pakistan.
⁴ Department of Surgery, Howard University College of Medicine, Washington, DC, USA.
⁵ Aga Khan University Hospital, Department of Surgery, Karachi, Pakistan. Electronic address: hasnain.zafar@aku.edu.

PMID: 25865084
DOI: 10.1016/j.ijsu.2015.03.023

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.

MeSH terms

Adult
Angiography / statistics & numerical data*
Embolization, Therapeutic / statistics & numerical data*
Female
Health Services Accessibility*
Hemorrhage / diagnostic imaging
Hemorrhage / therapy*
Hospital Mortality
Humans
Injury Severity Score
Male
Pakistan
Radiography, Interventional / statistics & numerical data*
Retrospective Studies
Trauma Centers
Wounds, Penetrating*