Indications

• Imaging evidence of arterial trauma

  • • CTA: active extravasation, pseudoaneurysm, AV fistula

    • Active extravasation almost always warrants angiography

    • Most aortic and extremity vascular injuries are handled by SRV

• Clinical evidence of arterial hemorrhage with suspicion of source

  • • Hypotension, tachycardia, transfusion requirement, pressor requirement despite resuscitation

    • Examples: hemodynamically unstable pt with known pelvic fx, iatrogenic injury of the profunda femoris artery during ortho fix

Contraindications

• Absolute: None, when intervention anticipated to be life-saving

• Relative:

  • • Uncorrectable bleeding diathesis

    • Contrast allergy (premedicate, as time allows)

    • Renal impairment

Imaging Review

• CTA (3-phase: noncon, arterial, delay) if available or as time allows

• Absence of hematoma / hemoperitoneum excludes the need for angio, but the lack of active extravasation does not always exclude active bleeding (especially true for pelvic hemorrhage when only venous phase available)

• AV Fistula can sometimes be seen as early contrast filling into adjacent vein

  • • May not require intervention if asymptomatic

• Options for access? CFAs open? Radial is often challenging due to vasoconstriction and time-pressure.

Tips for Workup

• How unstable is the patient?

  • • If imaging findings are not definitive, can they continue with conservative management?

    • Do they require Massive Transfusion / Anesthesia support?

    • Are they NPO for moderate sedation?

• Can coagulopathy be reversed? If not, arterial access sheath can be left in place after angio and removed by us the next day.

• Consent: Risk of non-target embolization, end-organ ischemia, contrast nephropathy, inability to localize bleed, access site complications