Penetrating abdominal or pelvic trauma may also be associated with significant haemorrhage from non-visceral arteries as shown in figure 1. Figure 1 a) Axial arterial phase contrast enhanced GS-1101 CT in a 23 year old man following a stab wound to the left buttock demonstrates haematoma within the gluteus muscles. Contrast enhancement medially (arrow) represents active haemorrhage
from the superior gluteal artery (Somatom sensation, 24 slice,Siemens, Erlangen, Germany). b) A Cobra catheter was negotiated into the posterior (somatic) left internal iliac artery from an ipsilateral approach. Active haemorrhage from a branch of the superior gluteal artery was demonstrated. c) A microcatheter system (Progreat) was negotiated into the bleeding vessel and 2 microcoils (Boston Scientific vortex fibred) were deployed (arrows). This completely abolished the bleeding with good perfusion of the buttock post procedure. The first large study
of the use of RG7112 order embolisation in both blunt and penetrating abdominal trauma demonstrated a similar success rate of over 90% . There was no difference between the success rates of embolisation for both. In over half the patients with penetrating trauma embolisation was used successfully after operative management failed to achieve haemostasis. The use of angiographic embolisation Y-27632 in vivo as a first-line treatment modality or as an adjunct to difficult surgery is supported by other studies . Interventional radiology techniques In the context of expanding the role of NOM of abdominal trauma interventional radiology is used to control haemorrhage, either acutely or to prevent re-bleeding from pseudo aneurysms or in a post surgical patient. The use of modern low osmolar contrast media (LOCM) for MDCT or angiography carries a small risk; mortality of 1 in 170,000 and severe or life threatening reactions of 1 in 40,000. In addition, if a patient has existing Aspartate acute renal failure
or severe chronic renal insufficiency, there is a risk of contrast induced nephropathy (CIN) of 5 to 50%. CIN is usually transitory and its significance is uncertain . In the context of life threatening haemorrhage and in comparison to surgical morbidity for these patients, the risk of CIN would appear to be acceptable. Occlusion balloons placed selectively and temporarily within internal iliac arteries, main visceral vessels or even within the aorta can be useful temporising measures. If there has been direct arterial trauma then assuming suitable anatomy stent graft or covered stent placement can provide a means to control the haemorrhage whilst preserving end organ blood supply. However, for solid organ haemorrhage embolisation is the most frequently used interventional technique. Many different types of embolic materials are available (Table 1).