title: Unstable patients with retroperitoneal vascular trauma: an endovascular approach.
abstract: BACKGROUND
  In hemodynamically unstable patients, the management of retroperitoneal vascular trauma is both difficult and challenging. Endovascular techniques have become an alternative to surgery in several trauma centers.
  
  
  METHODS
  Between 2004 and 2006, 16 patients (nine men, mean age: 46 years, range: 19-79 years) with retroperitoneal vascular trauma and hemodynamic instability were treated using an endovascular approach. The mean injury severity score was 30.7 ± 13.1. Mean systolic blood pressure and the shock index were 74 mm Hg and 1.9, respectively. Vasopressor drugs were required in 68.7% of cases (n = 11). Injuries were attributable to road traffic accidents (n = 15) and falls (n = 1). The hemorrhage sites included the internal iliac artery or its branches (n = 12) with bilateral injury in one case, renal artery (n = 2), abdominal aorta (n = 1), and lumbar artery (n = 1).
  
  
  RESULTS
  In all, 14 coil embolizations and three stent-grafts were implanted. The technical success rate was 75%, as early re-embolization was necessary in one case and three patients died during the perioperative period. Six patients died during the period of hospitalization (37.5%). No surgical conversion or major morbidity was reported.
  
  
  CONCLUSIONS
  In comparison with particulates, coil ± stent-graft may provide similar efficacy with regard to survival, and thus may be a valuable solution when particulate embolization is not available or feasible.
authors.affiliation: Department of Vascular Surgery, University Hospital Nord, Chemin des Bourrelly, Marseille Cedex 20, France. mourad.boufi@ap-hm.fr
authors.forename: Mourad
authors.initials: M
authors.lastname: Boufi
authors.forename: Sébastien
authors.initials: S
authors.lastname: Bordon
authors.forename: Bianca
authors.initials: B
authors.lastname: Dona
authors.forename: Olivier
authors.initials: O
authors.lastname: Hartung
authors.forename: Anthony
authors.initials: A
authors.lastname: Sarran
authors.forename: Sébastien
authors.initials: S
authors.lastname: Nadeau
authors.forename: Charlotte
authors.initials: C
authors.lastname: Maurin
authors.forename: Yves S
authors.initials: YS
authors.lastname: Alimi
mesh_terms: D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D019917:Blood Vessel Prosthesis Implantation; D004621:Embolization, Therapeutic; D057510:Endovascular Procedures; D005260:Female; D005602:France; D006439:Hemodynamics; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012187:Retroperitoneal Space / Q000098:blood supply*; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D055815:Young Adult