• Abdulaziz Alnumay, Natasha Caminsky, Jules Hugo Eustache, David Valenti, Andrew Neil Beckett, Dan Deckelbaum, Paola Fata, Kosar Khwaja, Tarek Razek, Katherine Marlene McKendy, Evan Gordon Wong, and Jeremy Richard Grushka.
• Division of Trauma and General Surgery, McGill University Health Centre, Montreal General Hospital Site, 1650 Cedar Ave Room L9-421, Montreal, QC, H3G 1A4, Canada.
• Eur J Trauma Emerg Surg. 2022 Feb 1; 48 (1): 315-319.

PurposeHemodynamically unstable trauma patients who would benefit from angioembolization (AE) typically also require emergent surgery for their injuries. The critical decision of transferring a patient to the operating room versus the interventional radiology (IR) suite can be bypassed with the advent of intra-operative AE (IOAE). Previously limited by the availability of costly rooms termed RAPTOR (resuscitation with angiography, percutaneous techniques and open repair) suites, it has been suggested that using C-arm digital subtraction angiography (DSA) is a comparable alternative. This case series aims to establish the feasibility and safety of IOAE.MethodsWe conducted a retrospective analysis of all trauma patients at our level 1 trauma center who underwent IOAE with a concomitant surgical intervention from January 2011 to May 2019. Descriptive analyses were conducted.ResultsA total of 49 patients (80% male, 44 ± 17 years, 92% blunt) underwent IOAE using the C-arm DSA during the study period. All but one patient underwent exploratory laparotomy, 56% of which underwent an additional surgical procedure (ex. exploratory thoracotomy, orthopedic). Either Gelfoam® (Pfizer, New York, USA) (90%), coils (2.0%), or a combination (8.2%) were used for embolization. Internal iliac embolization was performed in 88% of cases (59% bilateral). IOAE was successful in all but four cases (8.2%) and thirty-day mortality was 31%.ConclusionIOAE appears to be a feasible and safe management option in severe trauma patients with the advantage of concurrent operative intervention and ongoing active resuscitation with good success in hemorrhage control.© 2021. Springer-Verlag GmbH Germany, part of Springer Nature.

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