New Techniques in Hemorrhage Control

Abstract

The use of interventional procedures in trauma has increased steadily over the past 10 years. With advancements in both imaging and device technology, endovascular techniques have become part of the treatment algorithm for both large and small vessel injury. Endovascular therapy in trauma involves a minimally invasive, catheter-based approach, which can be used as a temporizing measure in patients in extremis or as definitive therapy in a wide variety of diagnoses. Sheaths, catheters, and guide wires are universal instruments, regardless of procedure. Devices passed over guide wires form the basis of diagnosis and treatment. Using this technology provides many advantages to traditional open surgical therapy, namely the avoidance of large and potentially morbid incisions. Angioembolization, stent grafting, and resuscitative endovascular balloon occlusion of the aorta (REBOA) are being used with increasing frequency in trauma centers, with established algorithms, multiinstitutional trials, and more published data available, particularly for solid-organ and pelvic hemorrhage. Key words: angiography, embolization, hemorrhage, resuscitative endovascular balloon occlusion of the aorta, stent graft