Interventional radiology
North of Scotland major trauma guidelines
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 |