Interventional Radiologist Dr. Chris Ingraham discusses his approach to treating solid organ and pelvic trauma, including embolization technique and IR's role in workflow efficiency for better trauma care.

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SHOW NOTES

In this episode, interventional radiologist Dr. Chris Ingraham and our host Dr. Michael Barraza discuss the role of IR in the trauma setting and approaches to embolization for trauma to the spleen, liver, kidneys, and pelvis.

Dr. Ingraham outlines Harborview Medical Center’s workup of trauma patients and describes the collaboration between the emergency, trauma surgery, and interventional radiology departments. Although CT provides more comprehensive imaging, Dr. Ingraham says that taking a patient directly to an angiogram could address the trauma quicker and prevent more complications. He also speaks about empiric embolization, noting that extravasation can be intermittent and not visible on imaging.

Overall, Dr. Ingraham recommends over-sizing coils, since patients are usually hypotensive and vasoconstrictive during active bleeding. Vessel diameter will eventually increase as patients are resuscitated.

When embolizing the spleen, Dr. Ingraham emphasizes that the goal is to prevent the need for splenectomy, especially in young patients, because of its role in immunologic responses. He advocates for proximal embolization in order to decrease the blood flow into the spleen and allow for splenic lacerations to clot and heal.

In liver embolization, Dr. Ingraham notes that there could be a laceration to the liver’s venous system, and embolization of the arterial system could reduce the dual blood supply of the liver. In these patients, there can be a higher risk of necrosis and biliary injury.

Finally, we discuss follow up care with pulse exams and monitoring of hemodynamic stability.

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RESOURCES

Balloons Up: Reduced Time to Angioembolization:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7903099/

SIR Trauma Guidelines, 2020:

https://www.jvir.org/article/S1051-0443(19)30952-2/fulltext