Endovascular Intervention for Trauma
Publication Date: January 14, 2020
Last Updated: March 14, 2022
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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Title
Endovascular Intervention for Trauma
Authoring Organization
Society of Interventional Radiology
Publication Month/Year
January 14, 2020
Last Updated Month/Year
August 16, 2023
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.