10 - Stent-Grafts, Coils, and Plugs

Abstract

Historically, angiography has been the gold standard for diagnosis of vascular trauma. Use of multidetector computed tomography in trauma patients has significantly decreased the need for diagnostic angiography in this population. What was once the main diagnostic modality for vascular trauma is now a platform for catheter-directed interventions for the acutely bleeding patient. Endovascular techniques are now widely accepted in the emergency management of many traumatic injuries. It has also become the preferred route of management for pseudoaneurysms and arterial venous fistulas that occur after solid organ injury. Catheter-based techniques for control of hemorrhage include occlusive embolization or reconstructive options using stent-grafting. Resuscitative endovascular techniques and management of traumatic aortic injury will be discussed elsewhere in this textbook. This chapter will focus on endovascular techniques for junctional vascular trauma, solid organ injury, pelvic injury, and iatrogenic injury as well as postoperative care. Although there has been an expansion of endovascular hemorrhage control, patient selection remains of paramount importance. Management of a hemodynamically unstable trauma patient continues to mandate immediate open operative intervention. Patients with solid organ or vascular injury who remain hemodynamically normal or respond appropriately to resuscitation may benefit from the decreased morbidity associated with endovascular interventions versus open exposure. Literature has shown high rates of success and decreased morbidity with endovascular hemorrhage control. Long-term outcomes continue to be investigated as this is an expanding therapy choice with increased use yearly.