Management of complicated lumbar artery injury after blunt trauma.

STUDY OBJECTIVE: Lumbar artery injury after blunt trauma is not frequently discussed. We review our experience with blunt lumbar artery injury management, especially alternative treatments in which embolization is not feasible. METHODS: We reviewed our trauma registry for 8 years 8 months. We sought all patients who sustained blunt torso trauma and had lumbar artery injury detected by angiography. Variables collected included demographic data, trauma mechanism, vital signs in triage, Injury Severity Score, associated injuries, computed tomography results, angiography results, embolizations, and outcome. RESULTS: Sixteen of the 3,436 patients in the trauma registry system had a blunt lumbar artery injury verified by angiography. For patients with lumbar artery injury, the mean Injury Severity Score was 38.6 (SD 12), and 10 (63%) of these 16 patients were in shock and 12 patients (75%) had closed head injuries. Angioembolization caused bleeding cessation in 11 patients but failed in 5 patients, who were treated conservatively. The overall mortality rate of patients with lumbar artery injury was 50%. CONCLUSION: Lumbar artery injury in multiply injured patients with blunt trauma leads to a high mortality rate, especially if accompanied by head injury. Embolization often stops bleeding, but, if embolization is not feasible, conservative treatment without retroperitoneal surgery can be successful.

Negative catheter angiography after vascular contrast extravasations on computed tomography in blunt torso trauma: an experience review of a clinical dilemma.

BACKGROUND: Catheter angiography is often arranged when vascular contrast extravasations on computed tomography (VCEC) presents after blunt torso trauma. However, catheter angiograph can be negative for bleeding and further management about this condition is not well discussed. The purpose of this study was a review of our experience of this discrepancy and to propose management principle. METHODS: We conducted a retrospective analysis of patients who received catheter angiography due to VCEC after blunt torso trauma at a level one trauma center in Taiwan from January 1, 2006 to December 31, 2009. Patient data abstracted included demographic data, injury mechanism, Injury Severity Score, vital signs and laboratory data obtained in the emergency department, CT and angiography results, embolization status, rebleeding and outcome. Analysis was performed according to angiographic results, VCEC sites, and embolization status. RESULTS: During the study period, 182 patients received catheter angiography due to VCEC, and 48 (26.4%) patients had negative angiography. The kidney had the highest incidence (31.7%) for a discrepant result. Non-selective proximal embolization under negative angiography was performed mostly in pelvic fracture and spleen injury. Successful treatment without embolization after negative angiography was seen in the liver, kidney and pelvic fractures. However, some rebleeding happened in pelvic fractures with VCEC even after embolization on negative angiography. CONCLUSIONS: A negative catheter angiography after VCEC is possible in blunt torso trauma, and this occurs most in kidney. Embolization or not under this discrepancy requires an integrated consideration of injury site, clinical presentations, and the risk of rebleeding. Liver and kidney in blunt torso trauma can be managed successfully without embolization when catheter angiography is negative for bleeding after VCEC.