A. Bhakta1, D. Magee1, M. Peterson1, M. S. O’Mara1 1Grant Medical Center / Ohio University,Trauma And Acute Care Surgery,Columbus, OHIO, USA
Introduction: Reduction of non-essential angiogram and embolization for patients sustaining blunt abdominal and pelvic trauma would allow improved utilization and decreased morbidity related to non-therapeutic embolization. We hypothesized that the nature of contrast extravasation (CE) on CT would be directly related to the finding of extravasation on angiogram and need for embolization.
Methods: A retrospective evaluation of trauma patients with CE on CT. Demographics, hemodynamics, and CE location and maximal dimension/volume were examined for relationship to CE on angiography and need for embolization. Primary complications were defined as nephropathy and pseudoaneurysm.
Results: 128 patients were identified with CE on CT. 64 (50.4%) also had CE identified on angiography requiring some form of embolization. Size of CE on CT was not related to CE on angiogram (p=0.69). Location of CE was related to need for embolization, with spleen embolization (85.4%) being much more frequent than liver (51.5%, p=0.006). Complication rate was 8.7% in all patients, and was not different between patients undergoing embolization and those who did not (p=0.40).
Conclusion: CE volume for patients was not predictive of continued bleeding and need for embolization. However, splenic injuries with CE required more embolization. In contrast, liver injuries were found to have infrequent ongoing CE on angiography. Complications associated with angiogram with or without embolization are infrequent, and CT findings may not be predictive of ongoing bleeding. We do not recommend selective exclusion of patients from angiographic evaluation when a blush is present.