Transcatheter Arterial Embolization in the Treatment of Maxillofacial Trauma Induced Life-Threatening Hemorrhages
| Autor: | Ruey-Fen Chen, Hsein-Jar Chiang, Iuan-Hong Tzeng, Wu-Chung Shen, Ying-Hsuan Li, Wei-Ching Lin, Yung-Fang Chen, Yu-Chien Lo |
|---|---|
| Rok vydání: | 2009 |
| Předmět: |
Adult
Male medicine.medical_specialty Blood transfusion Traumatic brain injury Critical Illness medicine.medical_treatment Hemorrhage Critical Care and Intensive Care Medicine Risk Assessment Sensitivity and Specificity Catheterization Cohort Studies Young Adult Injury Severity Score medicine Humans Glasgow Coma Scale Embolization Retrospective Studies business.industry Arterial Embolization Accidents Traffic Angiography medicine.disease Embolization Therapeutic Surgery Treatment Outcome Blood pressure medicine.anatomical_structure Anesthesia Accidental Falls Female Maxillofacial Injuries business Carotid Artery Internal Follow-Up Studies Artery |
| Zdroj: | Journal of Trauma: Injury, Infection & Critical Care. 66:1425-1430 |
| ISSN: | 0022-5282 |
| DOI: | 10.1097/ta.0b013e3181842046 |
| Popis: | BACKGROUND Life-threatening hemorrhages with hemodynamic instability are uncommon in patients with sustained maxillofacial trauma, but when they occur, require immediate surgical intervention if conservative treatment fails. This study assessed the effects of transcatheter arterial embolization (TAE) in the treatment of maxillofacial trauma-induced life-threatening hemorrhages. METHODS From January 2004 to January 2007, eight ambulatory patients admitted for maxillofacial injuries with life-threatening hemorrhaging and hemodynamic instability (systolic blood pressure < or = 90 mm Hg) caused primarily by intractable oronasal bleeding who subsequently underwent TAE were included in this study. RESULTS Maxillofacial trauma was caused by motorcycle traffic injuries (6 cases), motor vehicle injury (1 case), and fall injury (1 case). All patients exhibited documented Le Fort III fractures. The average Glasgow Coma Scale score was 4.7. TAE was successfully performed and hemorrhaging arrested in all patients. Three deaths occurred (38%) from severe traumatic brain injury. The other five patients (62%) survived without development of systemic or neurologic complications post-TAE. CONCLUSIONS Conservative treatment consisting of packing of the nares, compression, and blood transfusion should always precede TAE as the primary protocol. When conservative treatment fails, as shown either by the need for continued blood product replacement exceeding 1,500 mL and a systolic blood pressure < or = 90 mm Hg, TAE intervention should immediately be considered as an alternative recourse before other surgical interventions. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|