05.e.iv • Interventional radiology

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