Endovaskuläre Interventionen beim Polytrauma

Clinical issue

In recent years interventional radiology has significantly changed the management of injured patients with multiple trauma. Currently nearly all vessels can be reached within a reasonably short time with the help of specially preshaped catheters and guide wires to achieve bleeding control of arterial und venous bleeding.

Standard treatment/treatment innovations

Whereas bleeding control formerly required extensive open surgery, current interventional methods allow temporary vessel occlusion (occlusion balloons), permanent embolization and stenting.

Diagnostic work-up

In injured patients with multiple trauma preinterventional procedural planning is performed with the help of multidetector computed tomography whenever possible.

Performance

Interventional radiology not only allows minimization of therapeutic trauma but also a considerably shorter treatment time.

Achievements

Interventional bleeding control has developed into a standard method in the management of vascular trauma of the chest and abdomen as well as in vascular injuries of the upper and lower extremities when open surgical access is associated with increased risk. Additionally, pelvic trauma, vascular trauma of the superior thoracic aperture and parenchymal arterial lacerations of organs that can be at least partially preserved are primarily managed by interventional methods.

Practical recommendations

In an interdisciplinary setting interventional radiology provides a safe and efficient means of rapid bleeding control in nearly all vascular territories in addition to open surgical access.     

Interventional radiology in hepatobiliary trauma

Interventional radiologic techniques have become an important treatment tool in hepatobiliary trauma. We review the different methods and indications for these treatments. These include hepatic artery embolization for ongoing hemorrhage, arteriovenous fistula, or the presence of hemobilia. Case examples of each are given. Treatment of post-traumatic abdominal fluid collections is also described.     

Interventional radiology in the treatment of retroperitoneal trauma

Interventional radiology is used most often in the management of the trauma patient to control hemorrhage and drain fluid collections. Transcatheter arterial embolization is an effective, expeditious, and safe technique for the nonoperative control of renal and other retroperitoneal bleeding, arteriovenous fistulas, and pseudoaneurysms. Transcatheter drainage of renal and other retroperitoneal collections of pus, urine, and blood is successful in more than 90% of trauma patients; such drainage should be attempted prior to any surgical intervention. Other procedures, such as antegrade nephrostomy, ureteral stenting and dilatation, angioplasty of traumatic renal artery stenosis, and suprapubic cystostomy, are infrequently indicated but provide alternatives to standard surgical intervention.     

Interventional radiology in the treatment of retroperitoneal trauma

Interventional radiology is used most often in the management of the trauma patient to control hemorrhage and drain fluid collections. Transcatheter arterial embolization is an effective, expeditious, and safe technique for the nonoperative control of renal and other retroperitoneal bleeding, arteriovenous fistulas, and pseudoaneurysms. Transcatheter drainage of renal and other retroperitoneal collections of pus, urine, and blood is successful in more than 90% of trauma patients; such drainage should be attempted prior to any surgical intervention. Other procedures, such as antegrade nephrostomy, ureteral stenting and dilatation, angioplasty of traumatic renal artery stenosis, and suprapubic cystostomy, are infrequently indicated but provide alternatives to standard surgical intervention.     

周围血管性病变的介入治疗

周围血管性病变，通常是指肢体血管等外周血管的病变，包括动脉、静脉、动静脉联合病变等。本文主要介绍外周血管狭窄及闭塞性病变，包括动脉粥样硬化、血栓闭塞性脉管炎、大动脉炎以及动静脉畸形、肢体动脉瘤等病变的血管造影表现，介入治疗的方法及并发症的预防等，介入治疗是周围血管病变的一种方法简单、微创、疗效快的治疗方法。     

评介入学组与《介入放射学杂志》社关系的新篇章

介入放射学组与<介入放射学杂志>达成友好合作关系,经协商<介入放射学杂志>正式成为介入学组唯一的机关杂志.这一关系新篇章必将为推动我国介入事业进一步发展、促进<介入放射学杂志>快步走向国际,让世界了解中国的介入放射工作在疾病诊治中的作用.     

Thoracic angiography and intervention in trauma

Interventional radiologists are involved less often in the initial diagnostic evaluation of patients who have acute chest trauma today than in the past. Patients are cleared of significant injury by CT, or, when a significant injury is present, they are triaged appropriately to open surgery or endovascular intervention. Significant advances in catheter-based technology, such as stent grafts and embolization coils, allow definitive repair of thoracic aortic and branch vessel injury. The opportunity to treat these types of injury with minimally invasive techniques has reinforced a continuing need for the maintenance and continued development of skills in the performance and interpretation of thoracic angiography. This article reviews these techniques and examines the status and the future of endovascular interventions in thoracic trauma.     

Role of interventional radiology in the management of acute gastrointestinal bleeding

Acute gastrointestinal bleeding (GIB) can lead to significant morbidity and mortality without appropriate treatment. There are numerous causes of acute GIB including but not limited to infection, vascular anomalies, inflammatory diseases, trauma, and malignancy. The diagnostic and therapeutic approach of GIB depends on its location, severity, and etiology. The role of interventional radiology becomes vital in patients whose GIB remains resistant to medical and endoscopic treatment. Radiology offers diagnostic imaging studies and endovascular therapeutic interventions that can be performed promptly and effectively with successful outcomes. Computed tomography angiography and nuclear scintigraphy can localize the source of bleeding and provide essential information for the interventional radiologist to guide therapeutic management with endovascular angiography and transcatheter embolization. This review article provides insight into the essential role of Interventional Radiology in the management of acute GIB.     

介入技术在治疗多发伤合并腹部实质性脏器损伤中的价值

目的探讨介入栓塞技术治疗多发伤合并腹部实质性脏器损伤患者的价值。方法回顾性分析2012年7月—2016年7月治疗的50例多发伤合并有腹部实质性脏器损伤患者,平均年龄(39.6±11.6)岁,其中单纯肝脏损伤15例、脾损伤18例、肾损伤6例;两个实质脏器损伤11例。根据其治疗方式的不同,分为介入栓塞止血治疗的试验组(25例)和行传统剖腹手术止血的对照组(25例)。结果两组患者均止血彻底,试验组平均手术时间(53.8±7.9)min,平均输血量(612.0±176.9)m L,平均住院时间(18.9±3.2)d,未出现并发症及再次手术情况。对照组平均手术时间(57.8±61.5)min,平均输血量约(904.0±356.5)m L,平均住院时间(24.5±9.7)d。共出现并发症2例,其中1例肝脓肿,1例胆漏,经再次手术治疗痊愈。两组手术时间、平均住院时间、输血量、术后并发症及再次手术次数比较,试验组明显少于对照组(P0.05),差异有统计学意义。结论介入栓塞技术是治疗多发伤合并腹部实质性脏器损伤的有效措施,符合损害控制原理,具有创伤小、恢复快的特点,能有效减少患者输血量、并发症,提高多发伤救治成功率。     

Poul Erik Andersen's radiological work on Osteochondrodysplasias and interventional radiology

Poul Erik Andersen is a Professor and Interventional Radiologist at the University of Southern Denmark,Odense and Odense University Hospital,Denmark.His innovative and expertise is primarily in vascular interventions where he has introduced and developed many procedures at Odense University Hospital.His significant experience and extensive scientific work has led to many posts in the Danish Society of Interventional Radiology,the European Society of Radiology and the Cardiovascular and Interventional Radiological Society of Europe,where he is a fellow and has passed the European Board of Interventional Radiology-The European qualification in Interventional Radiology.     

Kidney trauma in children: state of the art medical imaging

Traumatic renal lesions have some particularities in the pediatric age group, especially for anatomic reasons. Imaging is very important for diagnosis and staging. Ultrasonography with Doppler is the first line examination performed in children and frequently allows initial diagnosis. From the Doppler-ultrasonographic results and the type of trauma, renal Computed Tomography (CT) is complementary performed. The association of these imaging techniques allows comprehensive work-up of traumatic renal lesions, and also of associated or pre-existing lesions. Conservative management is the rule in most cases. Interventional imaging techniques are sometimes used for therapeutic care of renal pedicular vascular lesions or lesions of the collecting system. Far from the traumatic event, imaging allows to follow up the morphologic and functional evolution of major renal lesions, in particular lesions of excretory renal ducts.     

The European Board of Interventional Radiology Examination: A Cross-Sectional Web-Based Survey

CardioVascular and Interventional Radiology - The Cardiovascular and Interventional Radiology Society of Europe established the European Board of Interventional Radiology (EBIR) as an international...     

Practice building in interventional oncology

Interventional Oncology is an exciting area of Interventional Radiology that represents one of the most rapidly expanding areas in the specialty. These vascular and nonvascular procedures are similar to or identical to other procedures performed by Interventional Radiologists, making practice development feasible in both the academic and private sectors. In this article, practical methods to target and expand individual practices are addressed along with ways to use physician extenders to maximize efficiency in practice.     

Dural and direct cavernous sinus fistulas.

Fistulas between the cavernous sinus and the carotid artery occur either after trauma or spontaneously. Unilateral exophthalmos is invariably the most conspicuous symptom. Until recently, treatment consisted of some method of occluding the carotid artery involved. Interventional catheter techniques have since been developed that use either Gelfoam embolization or released balloons. The results seem very promising, but long-term results of these new techniques are not yet available. Carotid-cavernous sinus fistulas may be dural or direct, each requiring a different interventional technique. Theredore, it is essential to determine the type involved by selective internal and external carotid angiography. This paper discusses 19 patients with carotid-cavernous fistulas, four of whom were successfully treated by catheter techniques. Gelfoam embolization was used in one case, and in three cases the fistula was closed with the aid of a balloon.     

介入放射学抑或介入医学

介入放射学是在放射影像诊断学基础上发展起来的一门新兴的微创治疗学.介入放射学的定义是:在医学影像设备导引下,应用穿刺针、导丝、导管等进行诊断及治疗的学科.介入放射学内容包含介入性诊断和介入性治疗.介入医学是从临床应用角度来定义的,介入放射学则是从诊疗技术特点来定义的.《介入放射学杂志》与即将出版的《介入医学杂志(英文)》形成姊妹篇,将为我国介入医学发展,提升国际影响力创造条件.     

骨盆骨折并髂血管损伤

目的 探讨骨盆骨折并髂血管损伤的早期诊治方法,方法 回顾性分析６年间收治的１２例骨盆骨折并髂管损伤病人的临床资料。结果 本组病人均有伴发伤及休克,其ＩＳＳ均大于１６分,平均３０．３２分,其中髂劝脉损伤１１例,髂外外动脉损伤１例,本组９例病人术后获救;死亡３例,死亡率为２５％,结论骨盆后 骶髂嵯节周围的严重损伤有时的会伴发致命的髂因管破裂,介入性血管栓塞技术及髂劝脉结扎术是救治创伤失血性休克的有效措     

Is it Time for a Specific Undergraduate Interventional Radiology Curriculum?

CardioVascular and Interventional Radiology - Interventional radiology (IR) is traditionally underrepresented in undergraduate medical curricula. Final-year medical students ought to be familiar...     

外伤性血管损伤的手术及介入治疗

目的 探讨外伤性血管损伤的外科手术及介入治疗方法 . 方法 分组回顾分析85例血管损伤的1临床资料.损伤部位包括颈静脉、椎动脉、四肢主干血管、肠系膜上动脉.其中交通伤25例、锐器伤60例.行手术治疗62例(血管移植术37例,血管修补术25例),介入治疗23例. 结果 死亡1例,截肢1例.两组共随访58例,所有患者损伤血管通畅情况良好. 结论 及时止确的诊断对于血管损伤的救冶意义重大.介入治疗血管损伤具有创伤小、手术时间短、操作简单、术后恢复快的优点.介入与手术方法 可联合应用丁血管损伤的治疗.     

巨大动脉瘤的介入治疗

目的探讨巨大动脉瘤介入治疗的方法及疗效。方法对7例巨大动脉瘤(包括肺动脉瘤2例,肾动脉瘤2例,肱动脉瘤1例,右髂总动脉瘤1例,右髂内动脉瘤1例;其中真性动脉瘤5例,假性动脉瘤2例;原因为先天性、外伤性以及动脉硬化所致)3例采用置入带膜血管内支架治疗,2例采用动脉瘤内填塞治疗,2例采用部分动脉瘤内填塞加供血动脉栓塞治疗。结果7例巨大动脉瘤顺利完成了介入治疗手术,技术成功率为100％。6例动脉瘤闭塞,症状体征消失;1例右髂内动脉瘤复发破裂死亡。未出现其他并发症。结论介入方法是治疗巨大动脉瘤的有效方法。     

Anesthesia Practices for Interventional Radiology in Europe

CardioVascular and Interventional Radiology - The Cardiovascular and Interventional Radiological Society of Europe (CIRSE) prompted an initiative to frame the current European status of anesthetic...