Contrast computed tomography was performed for patients with blunt
abdominal injuries, excluding those who did not respond to initial fluid
resuscitation. Angiography was performed for patients with
injuries showing contrast extravasation or solid organ injury classified, according to the American Association for the Surgery of
Trauma, as grade 3 or higher on computed tomography. Transcatheter arterial embolization was performed when angiography showed arterial extravasation. The protocol was abandoned for any patients who became profoundly hypotensive (with systolic blood pressure 60 mm Hg or lower) during computed tomography or angiography.
RESULTS: Between January 2000 and December 2002, 269 patients with blunt
abdominal injuries underwent TAE immediately after admission. Of these patients, 41 had
injuries in at least two regions and underwent TAE for these regions. Among them, 22 patients were hemodynamically stable or showed rapid response to fluid
resuscitation. The nonsurgical treatment was successful in all these cases. The remaining 19 patients (Injury Severity Score, 37.3 +/- 8.2), who showed a transient response, were the subjects of this study. Of these patients, 15 underwent TAE for
injuries in two regions (13 pelvic fractures, 7 splenic
injuries, 6 hepatic
injuries, 3 facial
bleeding, and 1 renal injury), and 4 patients underwent TAE for
injuries in three regions (4 had splenic
injuries, 3 hepatic
injuries, 2 renal
injuries, 2 pelvic fractures, and 1 facial
bleeding). For all these patients, TAE was successfully performed. Before TAE, the systolic blood pressure was 79.9 +/- 8.4 mm Hg, and the
shock index was 1.45 +/- 0.25 mm Hg. After TAE, the corresponding values were 120.6 +/- 19.3 mm Hg and 0.87 +/- 0.16 mm Hg, respectively (p < 0.001). The rate of fluid administration required after TAE (214.2 +/- 139.3 mL/hour) was significantly less than that required before TAE (1244.2 +/- 347.1 mL/hour; range, 632-1,728 mL/hour) (p < 0.001). The deaths of two patients were classified as nonpreventable on the basis of the
Trauma and Injury Severity Score (TRISS), and their respective probabilities of survival were determined to be 0.13 and 0.03.
CONCLUSION: