Angiointervention: high rates of failure following blunt XXXX .

@entity1 @entity8 @entity130
BACKGROUND: Nonoperative management (NOM) of solid organ injury after @entity130 is now standard. Recently, angioembolization (AE) has been used to extend NOM. Few data exist on evaluating NOM of blunt @entity8 (BRIs). We sought to determine the overall efficacy of NOM as well as the outcome of AE in @entity1 with BRI. METHODS: The trauma registry was used to identify all @entity1 with BRI between January 2002 and December 2008. Medical records were reviewed for demographics, grade of injury, use of angiographic intervention, and outcome. RESULTS: A total of 434 @entity1 with BRI were identified, 416 of whom had planned NOM; 337 (81%) @entity1 were successfully managed without further intervention for their BRI. In all, 79 (19%) @entity1 underwent angiography; 22 (27.8%) of these @entity1 underwent AE, and 6 (27.2%) failed 1.2    0.8 days after AE. @entity1 who failed AE had a significantly higher blood transfusion requirement during the first 24 h of admission (p = 0.01). Seven @entity1 not embolized failed 1.9    1.9 days after angiography. Thus, of the 79 @entity1 having angiography, 13 (16.5%) failed and required laparotomy to treat their BRIs. Overall failure rate of NOM was 3.1% (13/416). @entity1 who failed angiography, with or without AE, required more blood during the first 24 h after admission (p = 0.03). CONCLUSIONS: NOM of BRI is safe and effective, with an overall failure rate of 3.1%. However, angiography with or without AE has substantial failure rates. @entity1 with higher-grade injuries and active vascular extravasation on admission computed tomography scan also fail NOM regardless of therapy. The blood transfusion requirement during the first 24 h may indicate who will require operative intervention following angiography. Close observation and/or early laparotomy are wise for these high-risk @entity1 .
