Endovascular embolization in the treatment of patients with closed abdominal trauma

Background. Closed abdominal trauma is often accompanied by damage to the abdominal organs and retroperitoneal space. With the development of medicine, minimally invasive methods of treating patients with bleeding due to closed abdominal trauma have become available, including endovascular embolization of the bloodstream, which allows one to avoid traditional operations (laparotomy) in this category of patients and achieve rapid rehabilitation of patients.

Aim. To evaluate the possibility of X-ray endovascular embolization in the treatment of patients with closed abdominal trauma.

Materials and methods. At the Sklifosovsky Research Institute of Emergency Medicine in 2022–2024 treated 68 patients with a diagnosis of “closed abdominal trauma”, of which 14 underwent direct angiography. In 4 (28.6%) patients, the intervention was diagnostic, in 10 (71.4%) it was therapeutic and diagnostic. These patients were included in this study: 8 (57.1%) men and 6 (42.9%) women.

Results. Selective embolization of the splenic artery was performed in four (28.5%) cases, the renal artery in 2 (14.2%), the lumbar artery in 2 (14.2%), and the hepatic artery in 2 (14.2%). A retroperitoneal (perinephric) hematoma was punctured percutaneously under ultrasound guidance in one case to exclude urinary leakage in a patient with a kidney injury. One (7.1%) patient required laparotomy due to recurrent bleeding. There were no complications from X-ray endovascular interventions. There were no cases of hematoma infection. One (7.1%) death in a 70-year-old patient with a closed abdominal injury, subcapsular hematoma of the spleen with comorbid pathology.

Conclusion. The use of X-ray endovascular embolization made it possible to avoid traditional surgical interventions (laparotomy) in 20.6% of cases. The introduction of X-ray endovascular hemostasis is one of the priorities in the treatment of patients with closed abdominal trauma.