The role of IR in major trauma is to stop haemorrhage as quickly as possible with minimal interference as part of damage control resuscitation. Information supplied by the head to pelvis CT scan is key to informing the decision-making process.
- Trauma team leaders should be aware of possible indications for IR in trauma as detailed in the table below.
- Decisions on the use of IR should be made in conjunction with a senior clinician from the appropriate specialty.
- Once requested and the patient is on site, IR should be available within 30 minutes of referral.
| Site | Non-operative management | Interventional radiology | Damage control surgery |
| Thoracic aorta | No role except in small partial thickness tears | Stent graft for suitable lesions | Ascending aortic injury or arch injury involving great vessels |
| Abdominal aorta | No role | Occlusion balloon, stent graft for suitable lesions | Injury requiring visceral revascularisation or untreatable by EVAR |
| Peripheral / branch artery | No role | Occlusion balloon, stent graft for suitable lesions | Any lesion which cannot rapidly be controlled or which will require other revascularisation |
| Kidney | Subcapsular or retroperitoneal haematoma without active arterial bleeding | Active arterial bleeding, embolisation or stent graft | Renal injury in association with multiple other bleeding sites or other injuries requiring urgent surgery |
| Spleen | Lacerations, haematoma without active bleeding or evidence of false aneurysm | Active arterial bleeding or false aneurysm Focal embolisation for focal lesion Proximal embolisation for diffuse injury | Packing or splenectomy for active bleeding in association with multiple other bleeding sites |
| Liver | Subcapsular or intraperitoneal haematoma or lacerations without active arterial bleeding | Active arterial bleeding Focal embolisation if possible Non-selective embolisation if multiple bleeding sites as long as portal vein is patent | Packing if emergency laparotomy needed with subsequent repeat CT and embolisation if required |
| Pelvis | Minor injury with no active bleeding | Focal embolisation for arterial injury (bleeding, false aneurysm or cut-off) | External compression and subsequent fixation if bleeding from veins or bones |
| Intestine | Focal contusion with no evidence of ischaemia, perforation or haemorrhage | Focal bleeding with no evidence of ischaemia or perforation. Or, to stabilise patient, allow interval laparotomy pending treatment of other injuries | Ischaemia or perforation requiring laparotomy +/- bowel resection |
| Site | Management strategy options |
| Thoracic aorta | Non-operative management |
| No role except in small partial thickness tears | |
| Interventional radiology | |
| Stent graft for suitable lesions | |
| Damage control surgery | |
| Ascending aortic injury or arch injury involving great vessels | |
| Abdominal aorta | Non-operative management |
| No role | |
| Interventional radiology | |
| Occlusion balloon, stent graft for suitable lesions | |
| Damage control surgery | |
| Injury requiring visceral revascularisation or untreatable by EVAR | |
| Peripheral / branch artery | Non-operative management |
| No role | |
| Interventional radiology | |
| Occlusion balloon, stent graft for suitable lesions | |
| Damage control surgery | |
| Any lesion which cannot rapidly be controlled or which will require other revascularisation | |
| Kidney | Non-operative management |
| Subcapsular or retroperitoneal haematoma without active arterial bleeding | |
| Interventional radiology | |
| Active arterial bleeding, embolisation or stent graft | |
| Damage control surgery | |
| Renal injury in association with multiple other bleeding sites or other injuries requiring urgent surgery | |
| Spleen | Non-operative management |
| Lacerations, haematoma without active bleeding or evidence of false aneurysm | |
| Interventional radiology | |
| Active arterial bleeding or false aneurysm Focal embolisation for focal lesion Proximal embolisation for diffuse injury | |
| Damage control surgery | |
| Packing or splenectomy for active bleeding in association with multiple other bleeding sites | |
| Liver | Non-operative management |
| Subcapsular or intraperitoneal haematoma or lacerations without active arterial bleeding | |
| Interventional radiology | |
| Active arterial bleeding Focal embolisation if possible Non-selective embolisation if multiple bleeding sites as long as portal vein is patent | |
| Damage control surgery | |
| Packing if emergency laparotomy needed with subsequent repeat CT and embolisation if required | |
| Pelvis | Non-operative management |
| Minor injury with no active bleeding | |
| Interventional radiology | |
| Focal embolisation for arterial injury (bleeding, false aneurysm or cut-off) | |
| Damage control surgery | |
| External compression and subsequent fixation if bleeding from veins or bones | |
| Intestine | Non-operative management |
| Focal contusion with no evidence of ischaemia, perforation or haemorrhage | |
| Interventional radiology | |
| Focal bleeding with no evidence of ischaemia or perforation. Or, to stabilise patient, allow interval laparotomy pending treatment of other injuries | |
| Damage control surgery | |
| Ischaemia or perforation requiring laparotomy +/- bowel resection |