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Interventional radiology and trauma interventions

Interventional radiology and trauma interventions

The main thing we do is embolise bleeding
lesions; that’s our core business. But it involves much more. It also involves interpreting
the imaging, so the initial imaging, because selecting patients is probably as important
as doing the procedure itself, so it’s a combination of understanding the patient needs, understanding
the imaging, interpreting the imaging, having a good set of criteria for which patient
to do and which patient not to do. The most exciting things are treatment
of aortic rupture, traumatic aortic rupture, because basically surgical treatment has been
replaced by stent graft placement completely over the last few years and so that’s been
a major shift in treatment and also a major improvement in treatment. If you look at new treatments and workup algorithms
for trauma, the IR has a much more fixed place in the algorithms now. We recently made a
guideline with CIRSE and that features a very central role for IR in the treatment algorithms.
So the technique itself hasn’t changed considerably over the past few years, it’s more that the
use of the technique and where to use it has become much more fixed, thereby expanding
the number of patients that we are treating. Still not everyone is completely aware of
all the possibilities we have for treating aortic rupture, or bleeding of all
different types of organs – not only livers and spleens but also the pelvis, mesenteric
vessels, supra aortic branches going to the neck and the head, extremity trauma. I guess
not many people are aware of all the things that we can do, so we should be there to offer our
service and show them what we can do. So that’s why IR should be involved from the
start. For instance, what we’re seeing in our practice is, when a patient
comes in to the trauma bay, a clinically unstable patient or a patient under suspicion of serious
trauma, IR gets called in right away. So what happens usually is, we go down to the trauma
bay, we’re actually there when the trauma patient comes in and when the imaging occurs.
We do have direct access to CT scanning in the trauma bay so that we get the imaging
right away, we see if there’s a bleed or a false aneurysm or a cut-off artery, or anything
of that kind. We consult with the trauma surgeons straight away to discuss the haemodynamic
situation, the amount of time we would need to do the procedure, the indication for the
procedure, and then we either do or do not do the case. So this happens on a direct discussion
basis, in the presence of the patient in the trauma bay. That’s the way to do it. And this
probably should happen in every level one trauma centre. Of course, if you’re
going to do this, you have to have IRs who are always present and are
always available to consult 24/7. Very important: if you realise that two-thirds
of trauma patients, or even maybe more than two-thirds of trauma cases, will be out
of office hours, it becomes self-evident that you have to have the service 24/7.

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