E4519. Genitourinary Trauma: Classification, Management Strategies, and Patient Selection and Technical Approaches to Endovascular Treatment
Authors
Kristy Patel;
Rowan-Virtua, School of Osteopathic Medicine; University of Alabama at Birmingham
Alyssa Knight;
University of Alabama at Birmingham
Kasey Helmlinger ;
University of Alabama at Birmingham
Aliaksei Salei;
University of Alabama at Birmingham
Junjian Huang;
University of Alabama at Birmingham
Junaid Raja;
University of Alabama at Birmingham
Andrew Gunn;
University of Alabama at Birmingham
Background
The kidney is the most frequently injured organ within the genitourinary (GU) system, with it being implicated in as many as 5% of all traumas. Increasingly, TAE is the favored management strategy in hemodynamically stable patients that require intervention. TAE offers patients excellent clinical results, with a reduced recovery period and fewer complications when compared to either total or partial nephrectomy. As such, TAE is a well-accepted treatment for GU trauma by the Western Trauma Association (WTA), World Society of Emergency Surgery (WSES), and American Association for the Surgery of Trauma (AAST).
Educational Goals / Teaching Points
Diagnose and classify GU trauma through a case-based review of US and CT imaging findings. Review available management strategies for GU trauma, including observation, transarterial embolization (TAE), and surgery. Discuss approaches to patient selection for TAE. Understand technical considerations of TAE in GU trauma in a case-based format.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
CT with contrast or CTA are the most common diagnostic tests when evaluating a patient with suspected GU trauma. According to guidelines from the AAST, high-grade renal injuries include Grade III (laceration > 1 cm in the renal cortex or active extravasation), Grade IV (evidence of collecting system injury), and Grade V (shattered, avulsed, or devascularized kidney) injuries. Regarding management, societal guidelines generally separate patients based on their hemodynamic stability. Hemodynamically stable patients with low grade renal injuries can generally be observed but those with high-grade renal injuries should be referred for angiography. Hemodynamically unstable patients with suspected GU injury warrant surgical exploration. TAE for GU trauma results in high rates of clinical success with an overall low rate of major complications. The advent of smaller microcatheters and balloon-occlusion microcatheters allows for subselection of renal vessels, leading to preserved renal function. A variety of embolic agents, including gelatin sponge slurry, particles, coils, and liquid embolics can be successfully used.
Conclusion
Interventional radiologists play a significant and growing role for patients with high-grade traumatic renal injuries.
