Last updated March 14, 2022

Endovascular Intervention for Trauma

Recommendations

The development and adherence to evidence-based treatment algorithms for each trauma scenario is necessary to ensure streamlined and consistent care to optimize patient outcomes. (E, Strong)
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Operator expertise in the performance of endovascular interventions is essential for the trauma patient. Small- and large-vessel endovascular interventions each require distinct skill sets and training. (E, Strong)
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The development and adherence to evidence-based treatment algorithms for each trauma scenario in pediatric patients is necessary to ensure streamlined and consistent care to optimize patient outcomes. (E, Strong)
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Emergent thoracic endovascular aortic repair should be used in anatomically favorable grade 3 and grade 4 aortic injuries, with nonoperative management (antihypertensive and antiimpulse medication with close symptomatic and/or radiographic follow-up) favored for the management of grade 1 and grade 2 injuries (also known as minimal aortic injury). (D, Strong)
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Embolization for pelvic trauma should be first-line therapy and the standard of care over surgery. (D, Strong)
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Nonoperative management should be the treatment of choice in patients with blunt hepatic injury who are in hemodynamically stable condition, with embolization to be considered in cases of ongoing bleeding, identification of an arterial source of bleeding on imaging, or suspicion of persistent source of arterial bleeding despite operative intervention. (D, Weak)
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Splenic artery embolization should be considered for patients in hemodynamically stable condition with grade IV/V blunt splenic trauma. (D, Moderate)
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Embolization should be considered in patients in hemodynamically stable condition with any grade injury who have imaging or clinical evidence of ongoing splenic hemorrhage. (D, Weak)
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Angiography and embolization should be considered in patients with grade III/IV renal injuries when surgical exploration is not warranted as a result of other indications. (D, Strong)
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Embolization for active hemorrhage in the extremities should be considered in the appropriate context of expendability of the embolized artery. (D, Weak)
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Recommendation Grading

Overview

Title

Endovascular Intervention for Trauma

Authoring Organization

Publication Month/Year

January 14, 2020

Document Type

Consensus

External Publication Status

Published

Country of Publication

US

Document Objectives

The present position statement outlines parameters to consider in endovascular intervention in various organ systems. As new data emerge in the future, this evolving document will continue to be updated.

Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Older adult

Health Care Settings

Emergency care, Hospital, Radiology services

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Management, Treatment

Diseases/Conditions (MeSH)

D006471 - Gastrointestinal Hemorrhage, D006499 - Hepatic Artery, D022125 - Lacerations

Keywords

trauma, endovascular intervention

Source Citation

Padia SA, Ingraham CR, Moriarty JM, Wilkins LR, Bream PR, Tam AL, et al. Society of Interventional Radiology Position Statement on Endovascular Intervention for Trauma. J Vasc Interv Radiol. 2020;31(3):363-369.e2.