Transcatheter Arterial Embolization for Chest Wall Trauma—10-Year Experience from a Single Trauma Center

Abstract

Purpose To present our experience in transcatheter arterial embolization (TAE) for hemorrhage following blunt or penetrating chest wall trauma. We provide the reader with a pictorial summary of the full range of angiographic findings and embolization techniques utilized. Material and Methods We performed a retrospective review of all patients treated with TAE for this indication from August 2004 to August 2014 in our institution, a level I trauma center. Data were obtained from the electronic records, pre- and post-procedural imaging, procedure reports, and laboratory results. Results A total of 13 patients were treated during this period. Seven patients had blunt trauma to the chest wall. Four patients had penetrating injury (2 stabbings and 2 gunshot wounds). In 4 cases the injuries were iatrogenic (3 due to chest tube insertion and 1 blunt injury from cardiopulmonary resuscitation). Two patients were previously treated with thoracotomy, which failed to control the bleeding. Embolization of intercostal artery, internal mammary artery and branches of the lateral thoracic and axillary arteries were performed. In all cases, embolization was effective in controlling the hemorrhage. There were no complications related to the procedure. We discuss the spectrum of imaging findings in these cases. Technical aspects such as catheter and embolic material selection are also discussed with pictorial examples. Conclusions In our experience TAE is a safe and effective treatment option in the management of chest wall hemorrhage after blunt and penetrating trauma. This minimally invasive procedure is particularly valuable in patients with significant comorbidities and persistent hemorrhage. Interventionists working in a trauma setting must have a thorough knowledge of the anatomical features and collateral pathways of the chest wall vasculature.