VASCULAR INTERVENTIONAL RADIOLOGY (O ZURKIYA, SECTION EDITOR)
Trauma in the Great Vessels: from the Aorta to the Pelvis
Bruce Bordlee Jr.
Published online: 24 May 2017
Springer International Publishing AG 2017
Purpose of Review This review will focus on common
interventional techniques in treating traumatic injuries.
It will showcase the various methods and options for
treatment of injuries involving the aorta, solid organs,
and pelvic vasculature.
Recent Findings Angiography and the development of
transcatheter techniques and percutaneous interventions
have allowed interventional radiologists to be on the
front line in the management of trauma patients.
Combined with the advances in cross sectional imaging,
the interventional radiologist is an integral member of
the medical team. Percutaneous interventions for life-
threatening hemorrhages have spared patients the associ-
ated morbidity of open surgery. Endovascular repair of
vessel injuries and embolization of solid organ injuries
have continued to evolve into first line treatments in the
acutely ill patient.
Summary This review article will highlight the interven-
tional radiologist’s vital role in the setting of trauma and
emerging techniques in the rapidly evolving field of in-
Interventional radiology has evolved into an integral part of
trauma care. Using various techniques including transarterial
embolization, balloon occlusion, and stent-grafts, the inter-
ventional radiologist can provide life saving procedures
through a minimally invasive approach. In the acutely ill pa-
tient, avoiding open surgery can help speed recovery without
adding additional undo morbidity from surgery. The contin-
ued advances in cross sectional imaging and the background
radiology training give the interventional radiologist the
unique ability to quickly assess the diagnosis and possible
treatment options in the acute setting.
Traumatic Aortic Injury
Traumatic aortic injury (TAI) has an extremely high mortality
rate. The majority of patients who suffer from TAI die before
reaching the hospital. The on-scene fatality rate is 90%. Those
who make it to the hospital require urgent care to avoid the
high mortality associated with delays in treatment.
Additionally, other injuries to the aorta can coexist, such as
arterial dissection and damage to aortic branches.
Catheter angiography has long been considered the gold
standard for diagnosing TAI; however, CTA has shown sen-
sitivity, specificity, and accuracy similar to catheter angiogra-
phy and has become the first step for diagnosis in many hos-
pitals. In an unstable patient, transesophageal echocardiogra-
phy has also been shown to be an excellent diagnostic tool
[1•]. A chest radiograph is often used as a screening examina-
tion; it has a negative predictive value of 95%, but a specificity
of only 25% .
Several mechanisms have been suggested as a cause of TAI
including rapid deceleration in motor vehicle collisions, falls
This article is part of the Topical Collection on Vascular Interventional
* Constantino Peña
Miami Cardiac and Vascular Institute, 8900 Kendall Drive,
Miami, FL 33176, USA
Curr Trauma Rep (2017) 3:207–211