title: Angiographic embolization for major trauma in a low-middle income healthcare setting--A retrospective review.
abstract: BACKGROUND
  Interventional radiology (IR) provides a range of adjunctive techniques to assist with hemorrhage control after trauma that can be employed pre- or post-operatively. The role of IR in lower-middle income countries (LMICs) remains unexplored. This study describes the use of adjunctive angioembolization (AE) in severely injured patients following its recent implementation at an urban trauma center in a LMIC.
  
  
  METHODS
  Adult patients (≥ 16 years) requiring AE from 2011 to 2013 at a single trauma-care facility were included. Data was collected on demographic parameters, transfer status, injury severity score (ISS), emergency resuscitation characteristics, AE and operative characteristics, complications, and in-hospital mortality. Descriptive analyses were performed.
  
  
  RESULTS
  Thirty six patients underwent AE for trauma-related hemorrhagic complications and were included in the study. Average age was 31.5 (± 11.3) years with a male preponderance (91.7%). Penetrating trauma (61.1%) was the most common type of injury. The primary mechanism of injury was gunshot (58.3%). The median ISS was 24 (IQR: 20-29). Pre-operative AE was performed in 23 (63.9%) patients and these patients had a lower median ISS (22) than those who underwent post-operative AE (p = 0.015). Hepatic (55.6%) and pelvic (33.3%) trauma more commonly required radiological intervention. Bleeding from the right hepatic (n = 14), and the right internal iliac (n = 6) arteries and/or their branches, were more often embolized. Microcoils were the preferred AE agents (61.1%). Median length of hospital stay was 7.5 (IQR: 3-14) days. Eight (22.2%) patients did not survive.
  
  
  CONCLUSIONS
  With the availability of multi-detector computed tomography and a dedicated interventional radiology suite, implementation of AE for the care of trauma patients in LMIC settings is possible.
authors: Center for Surgery and Public Health (CSPH), Brigham and Women's Hospital, Harvard School of Public Health and Harvard Medical School, Boston, MA, USA.
authors: Adil Aijaz
authors: AA
authors: Shah
authors: Aga Khan University Hospital, Department of Surgery, Karachi, Pakistan.
authors: Abdul
authors: A
authors: Rehman
authors: Center for Surgery and Public Health (CSPH), Brigham and Women's Hospital, Harvard School of Public Health and Harvard Medical School, Boston, MA, USA.
authors: Adil Hussain
authors: AH
authors: Haider
authors: Aga Khan University, Department of Radiology, Karachi, Pakistan.
authors: Raza
authors: R
authors: Sayani
authors: Aga Khan University Hospital, Department of Surgery, Karachi, Pakistan.
authors: Raza Hasnain
authors: RH
authors: Sayyed
authors: Aga Khan University Hospital, Department of Surgery, Karachi, Pakistan.
authors: Kamran
authors: K
authors: Ali
authors: Department of Surgery, Howard University College of Medicine, Washington, DC, USA.
authors: Syed Nabeel
authors: SN
authors: Zafar
authors: Aga Khan University Hospital, Department of Surgery, Karachi, Pakistan.
authors: Zia-ur
authors: ZU
authors: Rehman
authors: Aga Khan University Hospital, Department of Surgery, Karachi, Pakistan. Electronic address: hasnain.zafar@aku.edu.
authors: Hasnain
authors: H
authors: Zafar
mesh_terms: D000328:Adult; D000792:Angiography / Q000706:statistics & numerical data*; D004621:Embolization, Therapeutic / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D010154:Pakistan; D015641:Radiography, Interventional / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014193:Trauma Centers; D014950:Wounds, Penetrating
keywords: Angiography; Embolization; Hemorrhage; Interventional radiology; Low-middle income country; Pakistan; Trauma