1. Traumatic arterial injuries: endovascular treatment Martha A. Quiodettis May 25, 2010

2. Milestones 1964 angioplasty 1967 selective vasoconstriction infusion for hemorrhage. (GI bleeding) 1969 the catheter-delivered stenting technique and prototype stent 1960-74 tools for interventions (guidewires, contrast injector) 1970 occlusive coils 1972 selective artery embolization for GI bleeding 1973 embolization for pelvic trauma 1981 embolization spleen trauma

3. Milestones 1983 ballon expandable stent 1985 self expandable stents 1991 abdominal aortic stent grafts Charles Dotter,MD, 1964= first catheter use to treat isquemic limb. “Father or Interventional Radiology”

17. Early arteriography +/- embolisation is important for unstable patients

43. Trends and outcomes of endovascular and open treatment for traumatic thoracic aortic injury 328 TTAI 2000-07 Age 39.3 years ± 18 years 80% male. Open repair 79.6% 20.4% underwent TEVAR. Additional major injuries 71.7% in the open repair vs 91.0% of the TEVAR group (P =.001). mortality rate for the 8-year period open repair vsTEVAR: 17% vs 6%, (odds ratio [OR] 3.19, 95% confidence interval [CI], 1.11-9.23; P =.024). TEVAR independently reduced the risk of death following surgical intervention for TTAI compared with the open procedure (OR 3.8, 95% CI, 1.28-10.99; P =.010). Respiratory complications open repair: 38% vs 24% (OR 1.95; 95% CI, 1.05-3.60; P =.032). Endoleak and distal embolization each occurred in 9% of patients after TEVAR. Conclusions There has been a shift toward endovascular management of patients with TTAI. This change in surgical strategy has been associated with less postoperative mortality and fewer pulmonary complications in patients suffering from TTAI. TEVAR is associated with significant device-related complications. Journal of Vascular Surgery Vol51.3. march 2010.

44. Carotid/Subclavian

47. Subclavian artey pseudoaneurysm after clavicle fracture Endograft+exclusion

49. Comparison of conservative and operative treatment for blunt carotid injuries: Analysis of the National Trauma Data Bank 842 BCI from 1,633,126 discharged blunt trauma patients (0.05%). Of these, 762 (90.5%) tx conservatively and 80 (9.5%) OR comparing open surgical to endovascular interventions Conclusion BCI is rare and carries a poor prognosis. Operative intervention is not associated with functional improvement or a survival advantage. This study was unable to support that less invasive endovascular treatment improves treatment outcome when compared to open surgery.

57. Peripheral arteries

58. Endovascular treatment for traumatic injuries of the peripheral arteries following blunt trauma Piffaretti Injury vol 38. Issue 9. 2007 series of 81 patients in 7 years haemorrhagic shock was present in three patients. common femoral (n = 2) subclavian (n = 2), axillary (n = 2) external iliac (n = 2), superficial femoral (n = 1), popliteal (n = 1). pseudoaneurysm (n = 4), dissection (n = 4), expanding haematoma (n = 1), and arterio-venous fistula (n = 1). Follow-up doppler CTA 6-month interval during the first year, and yearly thereafter. Results The lesion was excluded in all cases. All patients survived. Major complications did not occur. Mean hospitalisation was 13 days. Limb-salvage was 100%. Follow-up ranged from 3 to 60 months (mean 16); a late occlusion of a popliteal stent-graft was managed with another endovascular procedure. Feasible and effective

61. Complications Post implant sd. Puncture site and wound hematoma Endoleak /migration death Wound infection Occlusion gangrene