Background and Aims Since 1990s angiographic embolization is used in adult trauma for bleeding control and organ preservation. Experience in children is limited probably because of a higher success rate of non operative management for solid organ injuries (96–100%) and for technical limits due to smaller size of arteries. We present successful application of angiographic embolization in 2 adolescents.
Materials and Methods A 16 years old boy, involved in a scooter accident, presented with a pelvic trauma: extensive bones fractures associated with a large perineal wound extending to scrotum. At TC scan an arterial active bleeding was visible in pelvis. The second patient was a 17 years old polytraumatized boy, victim of a fall, who presented multiple blunt organ injuries (lungs, liver, spleen, left kidney) and bone fractures; at TC scan contrast extravasation was present in the lower pole of the spleen. Both patients were hemodynamically unstable.
Results First patient underwent, by a left femoral access, a selective angiography of hypogastric artery that permitted identification of the bleeding source: a scrotal branch of internal pudendal artery that undergoes embolization. In second patient angiography was conducted by a right femoral access: multiple pseudoaneurysms of the intraparenchymal splenic arteries had been identified and a superselective embolization was performed. Both patients reached hemodynamic stability after procedure. No complications occurred.
Conclusions Angiographic embolization can be a support to non operative management of trauma also in pediatric age to permit organ preservation and to avoid additional trauma of open surgery in critical patients.