PD46: Trauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) II
PD46-01: Patient Clinical and Radiographic Characteristics Associated with Failed Angioembolization as First-Line Therapy after Trauma: Results from the American Association for the Surgery of Trauma Genitourinary Trauma study
Friday, May 15, 2020
7:00 AM – 9:00 AM
Manuel Armas-Phan, Andrew J Cohen, Sorena Keihani, Nnenaya Agochukwu-Mmonu, Douglas M Rogers, Joshua A Broghammer, Richard A Santucci, Frank N Burks, Sean P Elliott, Bradley A Erickson, Raminder Nirula, Jeremy B Myers, Benjamin Breyer
Introduction: Nonoperative management strategies for traumatic injuries have been associated with lower hospital costs, earlier discharge, less intra-abdominal complications, & reduced transfusion rates. Angioembolization (AE) has been pivotal in the transition to increased nonoperative management. Despite wide use, trauma-related AE can fail & require additional interventions. This multi-institutional study sought to determine what clinical & radiographic factors associated with AE failure.
Methods: Patients were selected from the Multi-institutional Genito-Urinary Trauma Study (MiGUTS), a collaborative effort between the AAST & the Genito-Urinary Trauma Study Group. This database includes high-grade renal trauma (HGRT; AAST grades III-V) admitted to participating centers between 2-2014 & 2-2017. The inclusion criterion was any HGRT that underwent a diagnostic angiography & subsequently AE for renal and/or non-renal bleeding. This cohort was dichotomized into successful or failed AE. The AE was considered a failure if it was followed by (1) repeat angiography and/or (2) an exploratory laparotomy.
Results: A total of 72 patients underwent angiography & 46 subsequently received AE. Among those who underwent AE, 28 of 46 (61%) underwent AE for renal bleeding including 23 exclusively for renal bleeding & 5 for renal & non-renal bleeding. The AE failed for 21 (46%) patients. These patients had higher injury severity scores, renal injury grades, larger transfusion requirements at 4- & 24-hours, & longer hospital & ICU stays (p < 0.05). A total of 18 patients underwent renal AE & had initial radiographic data for review with 6 (33%) having a failed renal AE. The failed renal AE group had larger perirenal hematoma sizes.
Conclusions: AE for high-grade renal trauma failed in 46% of patients. This was associated with having more severe renal injuries, larger perirenal hematomas, more additional injuries, & larger transfusion requirements. Likely these characteristics are reflective of the severity of trauma injuries being treated & are probably less amenable to a single AE for effective treatment. Source of