[Effect of transcatheter angiographic embolization on massive haemorrhage from large wound due to crush syndrome after Wenchuan earthquake].

OBJECTIVE

To evaluate the safety and efficacy of transcatheter angiographic embolization (AE) in the control of massive haemorrhage from large wound due to crush syndrome after Wenchuan earthquake.

METHODS

From May 12 to May 26, 2008, 11 injured persons in Wenchuan earthquake with massive haemorrhage from large wound due to crush syndrome were treated, including 6 males and 5 females aged 16-36 years old (average 21 years old). All 19 wounds were infected. The hemorrhage was from the hip in 7 cases, the thigh stump in 3 cases, and the shoulder in 1 case. Six patients had hemorrhagic shock. All patients underwent arteriography to locate the bleeding artery, and transcatheter AE was performed according to the result of arteriography. Contrast-enhanced spiral CT scan and three-dimensional angiography were performed 48 hours after AE to evaluate leakage of contrast media and collapse of distal artery of embolism site.

RESULTS

Angiography for 11 injured persons after AE showed no occurrence of contrast media leakage, faint shadow to the distal branch artery of embolic level, and significant increase of blood pressure of the bleeding artery, indicating the embolization was successful. No active hemorrhage was evident in the wounds 48 hours after AE. For the 6 patients with hemorrhagic shock, obvious decrease of hemorrhage was observed after AE, gradual recovery of blood pressure and vital signs, and stability of their condition were evident after supportive therapy. During the first 24 hours after AE, total volume of infusion was 6 750-19 600 mL (average 8 740 mL), and total volume of blood and plasma transfusion was 1 800-6 400 mL (average 3 500 mL). In 6 cases, contrast-enhanced spiral CT scan demonstrated faint shadow of the distal artery without contrast media leakage, and three-dimensional CT angiography showed collapse of the distal artery; in the rest 5 cases, contrast-enhanced spiral CT scan demonstrated shadow of the distal artery without contrast media leakage, and three-dimensional CT angiography displayed the full-filling of distal artery with obviously decreased vascular cavity. No severe complications such as muscle necrosis in the buttock and hip, bladder necrosis, dysuria, fecal incontinence, and impotence occurred.

CONCLUSIONS

The transcatheter AE is a safe, fast, effective and mini-invasive method of controlling massive haemorrhage from large wound caused by crush syndrome after Wenchuan earthquake.