Embolisation for bleed post trauma

Embolization for traumatic bleeding is a life-saving interventional radiology procedure used to control haemorrhage resulting from trauma. The procedure involves the deliberate occlusion of blood vessels supplying the site of bleeding, thereby reducing blood loss and stabilising the patient. 

Indications

Embolization is indicated in cases of:

• Trauma: Injuries from accidents, falls, or violence that lead to significant internal bleeding 
• Non-responsive Bleeding: Cases where conventional methods (e.g., pressure, suturing) are ineffective or impractical.
• High-risk Surgical Areas: Bleeding in areas where surgery is complex and risky, such as the pelvis or retroperitoneum.

Procedure

The embolization procedure typically involves the following steps:

1. Preparation: The patient is prepared and positioned, and local or general anesthesia is administered depending on the case.
2. Access: A small incision is made, usually in the groin, to access the femoral artery.
3. Catheter Insertion: A catheter is inserted through the incision and guided to the site of bleeding using fluoroscopic imaging.
4. Embolic Agent Delivery: Embolic agents (such as coils, gel foam, or particles) are delivered through the catheter to occlude the blood vessels and stop the bleeding.
5. Completion: Once the bleeding is controlled, the catheter is removed, and the incision is closed.

Materials Used

The materials used in embolization can vary based on the specific needs of the patient and the location of the bleeding. Common embolic agents include:

• Coils: Small metal coils that induce clot formation.
• Gel Foam: A spongy material that temporarily occludes blood vessels.
• Particles: Tiny spheres that can permanently block small blood vessels.

Complications

While embolization is generally safe, potential complications include:

• Non-target Embolization: Unintended blockage of non-target vessels, potentially leading to tissue ischemia.
• Infection: Risk of infection at the catheter insertion site.
• Allergic Reaction: Rare reactions to the contrast dye used in imaging.
• Rebleeding: Recurrence of bleeding if the embolization is not completely effective.

Benefits

• Minimally Invasive: Less traumatic than open surgery.
• Rapid Stabilization: Quickly controls bleeding and stabilizes the patient.
• Reduced Recovery Time: Shorter hospital stays and faster recovery compared to surgical alternatives.

Risks

• Incomplete Occlusion: Potential for incomplete blockage of the bleeding vessel.
• Complications: As noted above, including infection and non-target embolization.

Conclusion

Embolization for traumatic bleeding is a critical intervention that can rapidly control haemorrhage and stabilise patients in emergency settings. By using minimally invasive techniques, interventional radiologists can effectively manage bleeding, reducing the need for more invasive surgical procedures and improving patient outcomes. This procedure is an essential tool in trauma care, offering a balance of efficacy and safety in managing life-threatening bleeding.