Carbon dioxide angiography during angioembolization for trauma patients increases the detection of active bleeding and leads to reliable hemostasis: a retrospective, observational study

• Published in: European journal of trauma and emergency surgery (Munich : 2007) 2024-10, Vol.50 (5), p.2147-2154
• Main Authors: Maruhashi, Takaaki, Kurihara, Yutaro, Kitamura, Ryoichi, Oi, Marina, Suzuki, Koyo, Asari, Yasushi
• Format: Article
• Language: English
• Subjects: Adult; Aged; Angiography; Carbon Dioxide; Contrast Media - adverse effects; Critical Care Medicine; Embolization; Embolization, Therapeutic - methods; Emergency Medicine; Female; Hemorrhage - diagnostic imaging; Hemorrhage - therapy; Humans; Intensive; Iodine; Male; Medical imaging; Medicine; Medicine & Public Health; Middle Aged; Observational studies; Original Article; Retrospective Studies; Sports Medicine; Surgery; Surgical Orthopedics; Traumatic Surgery; Wounds and Injuries - complications; Wounds and Injuries - therapy
• ISSN: 1863-9933; 1863-9941; 1863-9941
• DOI: 10.1007/s00068-024-02628-2

Background Angiography with carbon dioxide (CO 2 ) has long been used as an alternative when iodine contrast media (ICM) cannot be used due to allergy to iodine or renal dysfunction. Conversely, CO 2 angiography is also known as a provocation method for active bleeding. In this study, we examined the efficacy of CO 2 angiography in angioembolization (AE) for trauma patients. Methods This was a single-center, retrospective, observational study of trauma patients who underwent AE at our facility between January 2012 and April 2023. Results Within this period, 335 AEs were performed. CO 2 angiography was performed in 102 patients (30.4%), and in 113 procedures. CO 2 angiography was used to provoke active bleeding which went undetected using ICM in 83 procedures , and to confirm hemostasis after embolization in 30 procedures. Of the 80 procedures wherein, active bleeding was not detected on ICM, 35 procedures (43.8%) were detected using CO 2 . The spleen had the highest detection rate of active bleeding by CO 2 angiography among the organs. There were 4/102 (1.9%) patients with CO 2 contrast who underwent some form of reintervention. Two patients were re-embolized with n-butyl-2-cyanoacrylate because of recanalization after embolization with gelatin sponge. The other two patients had pseudoaneurysm formation which required reintervention, and CO 2 angiography was not used. Vomiting was the most common complication of CO 2 angiography in 10 patients (9.8%), whereas all were transient and did not require treatment. Conclusions CO 2 angiography of trauma patients may have a better detection rate of active bleeding compared with ICM, leading to reliable hemostasis.