Transcatheter Arterial Embolization of Traumatic Lumbar Artery Injury: Experience in One Institution

Transcatheter arterial embolization has been well recognized and popular for the management of traumatic lumbar artery injury (TLAI). Current evidence regarding the management of TLAI is still based on case reports and a few small series of studies. The purpose of the study is to evaluate the efficacy and results of embolotherapy in the management of lumbar artery trauma in our hospital, a 3000-bed tertiary hospital in the Northern Taiwan. We retrospectively recruited all patients who underwent angiography and transcatheter arterial embolization (TAE) for lumbar artery injury from April 2004 to December 2008. Angiographic images and procedural reports were reviewed to assess immediate results. Trauma mechanism, associated trauma, injury severity score, clinical outcomes and post-embolization complications were obtained by chart review. Of seventeen patients with lumbar artery injury who underwent angiography, selective embolization was performed in fourteen patients. All fourteen patients exhibited immediate angiographic success. The overall mortality was 36% (5/14). However, there was only one suspected TLAI-related death. Two patients had minor neurological complaints in the follow-up period. No patient exhibited major neurological deficits or soft tissue complications. Traumatic lumbar arterial injury is an uncommon condition that requires a high index of clinical suspicion in the patients of retroperitoneal hemorrhage. According to the literature and our experience, TAE is a safe and effective method to achieve hemostasis. Correspondence Author to: Yon-Cheong Wong Department of Medical Imaging and Intervention, Chang-Gung Memorial Hospital at Linkou, Taoyuan, Taiwan No 5, Fu-Hsing Street, Guei-Shan, Taoyuan 333, Taiwan J Radiol Sci 2011; 36: 31-36 TAE in Traumatic Lumbar Artery Injury 32 J Radiol Sci March 2011 Vol.36 No.1 MATERIALS AND METHODS Patients The institutional review board at our hospital reviewed and approved the study. This study enrolled all patients of angiography-proved TLAIs from April 2004 to December 2008. Patients with retroperitoneal neoplasm, underlying bleeding disorder, and iatrogenic injuries related to percutaneous procedures or cardiac catheterization were excluded. The initial population consisted of 17 patients (16 males, age range: 13-62 years; and one female, age: 62 years). The trauma mechanism, injury severity score (ISS), associated injury, angiographic images, procedural reports, and clinical outcome were reviewed. All patients underwent abdominal computed tomography (CT) for the initial evaluation. The indications Figure 1. a . Cont rast-enhanced computed tomography (CT) of a 24-year-old man (patient 11) sustained a stabbing injury. Note a pseudoaneurysm (arrow) at the left paravertebral region. b. Selective arteriography of the left third lumbar artery showed a pseudoaneurysm (arrow). c. Superselective embolization was performed with microcoils (arrow) deployed in the main trunk and dorsal branch. The abnormal pseudoaneurysm disappeared after embolization. The patient was later discharged uneventfully.