1. Transcatheter embolisation in Trauma Experience at The RVI MTC 2012-2014 Dr J Y Graham Consultant Radiologist RVI

2. Transcatheter embolisation in Trauma Experience at The RVI MTC 2012-2014 Transcatheter angiography and embolisation has a long history (1974) in identifying and reducing blood flow and delivery of therapeutic agents. Can be used to control ongoing haemorrhage in both blunt and penetrating trauma. Effective (control of bleeding rates 85-100%). Safe and well tolerated Good for arterial bleeding, less so for venous or bony sources. Limitation is availability.

3. Transcatheter embolisation in Trauma Experience at The RVI MTC 2012-2014 Retrospective review of all patientsundergoing transcatheter embolisation of uncontrolled bleeding over a 2 year period following introduction of the MTC. Pelvic injuries and embolisations selected. Pelvic embolisations measured against orthopaedic data.

4. + + Interventional radiology Seldinger technique Usually common femoral artery access Selective catheter and guidewire Angiography to diagnose source of bleeding Transcatheter embolisation to arrest bleeding Angiography

5. Interventional radiology 2 year period SiteNumber Renal1 Spleen2 Mesenteric4 Peripheral2 Soft tissue3 Pelvic6 Penetrating1 Total18

6. Interventional radiology 2 year period SiteNumber Outcomes Renal1 Spleen2 Mesenteri c 4 Peripheral21 upper limb 1 lower limb (iliac artery) Soft tissue33 pelvic/lumbar1 died Pelvic64 vertical shear # 1 acetabular #4% of pelvic # 2 died (of other injuries) Penetratin g 1Pelvic stabbing Total18

7. Pelvic fractures April-Sept 2014 Non operativeOperativeTotal 291544 10 acetabular (176 estimate for 2 years)

10. Pelvic fracture in binder

15. +

30. Transcatheter embolisation in Trauma Experience at The RVI MTC 2012-2014 Limited numbers Effective when used.

31. Transcatheter embolisation in Trauma Experience at The RVI MTC 2012-2014 Limited numbers Effective when used. Success depends on: Early recognition Team working/multidisciplinary support Communication