Background

The role of IR is to stop haemorrhage as quickly as possible with minimal interference to the patient’s physiology. It is as much a form of damage control as surgical packing or pressing on a bleeding artery.

Referral and activation times

Where active extravasation is seen, discussion with the on-call General Radiologist should take place to assess potential for involving Interventional Radiology. If potentially suitable, the on-call interventional radiologist should be contacted by the TTL or a nominated team member.

IR teams should be in place within 30 minutes of activation. Early warning/activation must be considered in select patients.

Indications for intervention

Organ Exclusions (surgery indicated) Intervention

Kidney – active arterial bleeding

Multiple other bleeding sites or other indication for surgery

 Embolisation or stent graft
Spleen – active arterial bleeding or pseudoaneurysm Multiple other bleeding sites or other indication for surgery Focal or proximal embolisation
Liver – active arterial bleeding or pseudoaneurysm or failed surgery Multiple other bleeding sites or other indication for surgery Focal or non-selective embolisation if portal vein patent
Pelvis - active arterial bleeding, pseudoaneurysm or cut-off Multiple other bleeding sites or other indication for surgery Focal embolisation
Thoracic Aorta distal to left subclavian artery Ascending or arch involving great vessels Stent Graft