Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Jan;82(1):126-132.
doi: 10.1097/TA.0000000000001154.

Availability of on-site acute vascular interventional radiology techniques performed by trained acute care specialists: A single-emergency center experience

Junya Tsurukiri  1 , Shoichi Ohta, Shiro Mishima, Hiroshi Homma, Eitaro Okumura, Itsuro Akamine, Masahito Ueno, Jun Oda, Tetsuo Yukioka
Affiliations

Availability of on-site acute vascular interventional radiology techniques performed by trained acute care specialists: A single-emergency center experience

Junya Tsurukiri et al. J Trauma Acute Care Surg. 2017 Jan.

Abstract

Introduction: Comprehensive treatment of a patient in acute medicine and surgery requires the use of both surgical techniques and other treatment methods. Recently, acute vascular interventional radiology techniques (AVIRTs) have become increasingly popular, enabling adequately trained in-house experts to improve the quality of on-site care.

Methods: After obtaining approval from our institutional ethics committee, we conducted a retrospective study of AVIRT procedures performed by acute care specialists trained in acute medicine and surgery over a 1-year period, including those conducted out of hours. Trained acute care specialists were required to be certified by the Japanese Association of Acute Medicine and to have completed at least 1 year of training as a member of the endovascular team in the radiology department of another university hospital. The study was designed to ensure that at least one of the physicians was available to perform AVIRT within 1 h of a request at any time. Femoral sheath insertion was usually performed by the resident physicians under the guidance of trained acute care specialists.

Results: The study sample comprised 77 endovascular procedures for therapeutic AVIRT (trauma, n = 29, and nontrauma, n = 48) among 62 patients (mean age, 64 years; range, 9-88 years), of which 55% were male. Of the procedures, 47% were performed out of hours (trauma, 52%; and nontrauma, 44%). Three patients underwent resuscitative endovascular balloon occlusion of the aorta in the emergency room. No major device-related complications were encountered, and the overall mortality rate within 60 days was 8%. The recorded causes of death included exsanguination (n = 2), pneumonia (n = 2), sepsis (n = 1), and brain death (n = 1).

Conclusion: When performed by trained acute care specialists, AVIRT seems to be advantageous for acute on-site care and provides good technical success. Therefore, a standard training program should be established for acute care specialists or trauma surgeons to make these techniques a part of the standard regimen.

Level of evidence: Therapy/care management study, level V.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Workflow of AVIRT activation at the ED.
See this image and copyright information in PMC

References

    1. Morozumi J, Ohta S, Homma H, Sasaki H, Oda J, Suzuki K, Ohtaka Y, Noda M, Mishima S, Yukioka T. Introduction of mobile angiography into the trauma resuscitation room. J Trauma. 2009;67(2):245–251. - PubMed
    1. Morozumi J, Homma H, Ohta S, Noda M, Oda J, Mishima S, Yukioka T. Impact of mobile angiography in the emergency department for controlling pelvic fracture hemorrhage with hemodynamic instability. J Trauma. 2010;68(1):90–95. - PubMed
    1. American College of Surgeons Committee on Trauma. Resources for optimal care of the injured patient. 2014. Available at: https://www.facs.org/quality% 20programs/trauma/vrc/resources. Accessed March 10, 2016.
    1. Japanese Association for Acute Medicine. Mission Statement. Available at: http://www.jaam.jp/html/english/english-top.htm. Accessed April 2, 2016.
    1. Tempaku A, Yamauchi S, Ikeda H, Tsubota N, Furukawa H, Maeda D, Kondo K, Nishio A. Usefulness of interventional embolization of the middle meningeal artery for recurrent chronic subdural hematoma: five cases and a review of the literature. Interv Neuroradiol. 2015;21(3):336–371. - PMC - PubMed

LinkOut - more resources